Individual provider · Type 1 NPI

Melissa A. Detrie, LPC, SAC-IT

Professional Counselor · Green Bay, WI

NPI number 1205525904 Active

Practice location

2640 W Point Rd
Green Bay, WI 54304-1344

Call (920) 490-3875 Map

Mailing address

1566 W Mason St Ste 5
Green Bay, WI 54303-2274

Specialties and licenses

TaxonomyCodeLicense
Professional Counselor 101YP2500X6401225600 (MI)
Professional Counselor Primary 101YP2500X11880-125 (WI)
Addiction (Substance Use Disorder) Counselor 101YA0400X20395-130 (WI)

Professional Counselor: Definition to come...

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About NPI 1205525904

Melissa A. Detrie, LPC, SAC-IT's National Provider Identifier is 1205525904, issued on May 8, 2023. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Green Bay, WI. The record was last updated on Apr 17, 2026.