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1861924722
JOHN SMITH
MESA, AZ
NPI
1861924722
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: AZ LISAC-10251)
Enumeration Date
2017-03-30
Last Update Date
2017-03-30
Business Address
-- JOHN SMITH
245 N CENTENNIAL WAY
MESA, AZ 85201-6702
Phone number: 602-908-7904
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Mailing Address
-- JOHN SMITH
245 N CENTENNIAL WAY
MESA, AZ 85201-6702
Phone number: 602-908-7904
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