Individual
ANDREA PHOUTHAVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
319 LOGAN ST, CIRCLEVILLE, OH 43113-2213
(740) 474-8874
Mailing address
4449 STATE ROUTE 159, CHILLICOTHE, OH 45601-8620
(740) 775-1260
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
S.2308869
OH
Other
Enumeration date
03/06/2023
Last updated
03/06/2023
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