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1134711708
CORNELIUS LEE MINGO
FAIRBANKS, AK
NPI
1134711708
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2021-02-05
Last Update Date
2021-02-05
Business Address
CORNELIUS LEE MINGO
542 4TH AVE STE B101
FAIRBANKS, AK 99701-4707
Phone number: 907-374-1097
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Mailing Address
CORNELIUS LEE MINGO
PO BOX 73004
FAIRBANKS, AK 99707-3004
Phone number:
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