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General NPI Number Information
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NPI Number | 1003936899
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Entity Type | Organization
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Legal Business Name | COMMUNITY COUNSELING CENTER OF MADISON, WI, INC.
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6629 UNIVERSITY AVE SUITE 209
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City | MIDDLETON
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State | WI
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Zip | 53562-3037
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Country | US
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Telephone | 608-833-5880
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Fax | 608-829-3787
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Provider Business Mailing Address
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Address Line | 6629 UNIVERSITY AVE SUITE 209
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City | MIDDLETON
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State | WI
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Zip | 53562-3037
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Country | US
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Telephone | 608-833-5880
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Fax | 608-829-3787
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SHARON A BARGER
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Credential | PH.D.
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Telephone | 608-833-5880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1222
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License Number State | WI
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