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General NPI Number Information
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NPI Number | 1124093547
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Entity Type | Organization
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Legal Business Name | COUNSELING ASSOCIATES OF DOOR COUNTY, LLC
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Dates
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Enumeration Date | 02/20/2006
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Last Update Date | 02/07/2023
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Provider Practice Location Address
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Address Line | 620 N 12TH AVE
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City | STURGEON BAY
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State | WI
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Zip | 54235-1249
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Country | US
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Telephone | 920-743-9554
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Fax | 920-743-1591
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Provider Business Mailing Address
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Address Line | PO BOX 873
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City | STURGEON BAY
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State | WI
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Zip | 54235-0873
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Country | US
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Telephone | 920-559-7482
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Fax | 920-743-1591
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Authorized Official
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Title or Position | CLINIC OWNER
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Name | WILLIAM G NICK
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Credential | MSE, LCSW
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Telephone | 920-743-9554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2924-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1250
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License Number State | WI
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