TYQUAN BRACKER

STATEN ISLAND, NY
NPI1972997930
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2015-03-26
Last Update Date2015-03-26
Business Address
-- TYQUAN BRACKER
460 BRIELLE AVE
STATEN ISLAND, NY 10314-6427
Phone number: 718-816-6589
Mailing Address
-- TYQUAN BRACKER
460 BRIELLE AVE
STATEN ISLAND, NY 10314-6427
Phone number:
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