Individual
MRS. ALICIA VICTORIA DEMONTEGNAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
4085 RAVINA TER, SAINT JOSEPH, MI 49085-9655
(269) 240-4631
Mailing address
4085 RAVINA TER, ST. JOSEPH, MI 49085
(269) 240-4631
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6401012005
MI
Other
Enumeration date
08/14/2013
Last updated
08/14/2013
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