Provider Demographics
NPI:1083045801
Name:HUNTER, THEA CS (CSAC, LPC, ICS)
Entity type:Individual
Prefix:MS
First Name:THEA
Middle Name:CS
Last Name:HUNTER
Suffix:
Gender:F
Credentials:CSAC, LPC, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5355 ROOT RIVER DR
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2829
Mailing Address - Country:US
Mailing Address - Phone:262-914-9787
Mailing Address - Fax:
Practice Address - Street 1:5355 ROOT RIVER DR
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-2829
Practice Address - Country:US
Practice Address - Phone:262-914-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16187101YA0400X
WI7854101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)