Provider Demographics
NPI:1477873388
Name:ATTIC CORRECTIONAL SERVICES
Entity Type:Organization
Organization Name:ATTIC CORRECTIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MORLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-830-1750
Mailing Address - Street 1:PO BOX 1546
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54912-1546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3805
Practice Address - Country:US
Practice Address - Phone:920-830-1750
Practice Address - Fax:920-830-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1184859936251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health