Individual
MARY SANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PC-IT; SAC-IT
Contact information
Practice address
6110 W CAPITOL DR, MILWAUKEE, WI 53216-2120
(414) 393-0295
(414) 393-1155
Mailing address
6400 INDUSTRIAL LOOP, GREENDALE, WI 53129-2452
(414) 423-4100
(414) 423-4134
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
05/11/2016
Last updated
05/11/2016
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