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Individual
STANLEY THEODOREDIS
Active
Individual
STANLEY THEODOREDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, CAADC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
PC009228
PA
101YM0800X
Mental Health Counselor
Primary
PC009228
PA
Other
Enumeration date
03/02/2017
Last updated
02/15/2018
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