Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 15521 | WI |
NPI | 1003116393 |
---|---|
Provider Name | Lance P Armstrong |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53711-6227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2010 |
Last Update Date | 07/12/2010 |