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1639785033
TRACY MICKELSON
ELMIRA, NY
NPI
1639785033
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2020-09-21
Last Update Date
2020-09-21
Business Address
TRACY MICKELSON CASAC
1149 SULLIVAN ST STE B
ELMIRA, NY 14901-1670
Phone number: 607-733-7661
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Mailing Address
TRACY MICKELSON CASAC
1149 SULLIVAN ST STE B
ELMIRA, NY 14901-1670
Phone number: 607-733-7661
Copy
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