Provider Demographics
NPI:1194958538
Name:STONE, DARRELL R (SUBSTANCE COUNSELOR)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:R
Last Name:STONE
Suffix:
Gender:M
Credentials:SUBSTANCE COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 WCAPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222
Mailing Address - Country:US
Mailing Address - Phone:414-231-9326
Mailing Address - Fax:
Practice Address - Street 1:561 N 15TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2237
Practice Address - Country:US
Practice Address - Phone:414-288-4556
Practice Address - Fax:414-288-6100
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15081-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)