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1972997930
TYQUAN BRACKER
STATEN ISLAND, NY
NPI
1972997930
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2015-03-26
Last Update Date
2015-03-26
Business Address
-- TYQUAN BRACKER
460 BRIELLE AVE
STATEN ISLAND, NY 10314-6427
Phone number: 718-816-6589
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Mailing Address
-- TYQUAN BRACKER
460 BRIELLE AVE
STATEN ISLAND, NY 10314-6427
Phone number:
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