Provider Demographics
NPI:1598058562
Name:ATTIC CORRECTIONAL SERVCIES
Entity Type:Organization
Organization Name:ATTIC CORRECTIONAL SERVCIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENT QUALITY ASSURANCE OFFIC
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-223-0017
Mailing Address - Street 1:601 ATLAS AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-3181
Mailing Address - Country:US
Mailing Address - Phone:608-223-0017
Mailing Address - Fax:
Practice Address - Street 1:1699 SCHOFIELD AVE STE 116
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-2377
Practice Address - Country:US
Practice Address - Phone:715-355-0671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15641-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty