Individual
MR. OCTAVIAN BISTRICEANU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
1550 N CRESTMONT DR, MERIDIAN, ID 83642-2184
(208) 288-4200
Mailing address
361 W WHITETAIL CT, KUNA, ID 83634-3199
(208) 409-2258
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
ID
Other
Enumeration date
01/05/2017
Last updated
01/05/2017
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