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General NPI Number Information
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NPI Number | 1720132053
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Entity Type | Individual
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Provider Name | SUSAN M SEBASTIAN LPC, CSAC. INDCS
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Gender | Female
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 12/09/2008
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Provider Practice Location Address
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Address Line | 162 W MAIN ST SUITE G
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City | WHITEWATER
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State | WI
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Zip | 53190-1995
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Country | US
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Telephone | 608-446-0888
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Fax | 866-289-2601
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Provider Business Mailing Address
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Address Line | 162 W MAIN ST SUITE G
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City | WHITEWATER
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State | WI
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Zip | 53190-1995
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Country | US
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Telephone | 608-446-0888
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Fax | 866-289-2601
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3734-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2050-132
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License Number State | WI
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