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General NPI Number Information
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NPI Number | 1194958538
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Entity Type | Individual
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Provider Name | DARRELL R STONE SUBSTANCE COUNSELOR
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Gender | Male
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Dates
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Enumeration Date | 09/02/2009
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Last Update Date | 09/02/2009
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Provider Practice Location Address
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Address Line | 561 N 15TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53233-2237
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Country | US
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Telephone | 414-288-4556
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Fax | 414-288-6100
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Provider Business Mailing Address
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Address Line | 9700 WCAPITAL DR
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City | MILWAUKEE
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State | WI
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Zip | 53222
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Country | US
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Telephone | 414-231-9326
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15081-130
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License Number State | WI
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