Theodore Gongola
Theodore Gongola is a Counselor in Russellville, Arkansas. Registered with an NPI since 2012.
- In the registry since
- 2012
Practice location Address checks out
3205 W Main StRussellville, AR 72801-2301
Phone: (479) 967-4673
Fax: (479) 967-7140
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Counselor (primary) | Taxonomy 101Y00000X |
|---|
Record details
| NPI number | 1053656108 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | No |
| NPI enumerated | November 30, 2012 |
| Last updated in NPPES | November 30, 2012 |
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