Individual
MR. MARK GONCHAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LASAC
Contact information
Practice address
3095 E CORONADO TRL, RIMROCK, AZ 86335-5284
(928) 567-1322
Mailing address
PO BOX 230, RIMROCK, AZ 86335-0230
(928) 567-1322
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
13156
AZ
Other
Enumeration date
09/11/2018
Last updated
09/11/2018
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