Individual
MR. ANDREW KEODARA PHOMTHAVONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
298 WALKER STREET, LOWELL, MA 01851
(619) 743-9052
Mailing address
298 WALKER ST, LOWELL, MA 01851-1848
(619) 743-9052
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
01/06/2011
Last updated
01/06/2011
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