Individual
RAISA C MONTALVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2101 ELM ST N, FARGO, ND 58102-2417
(701) 239-3700
Mailing address
3001 34TH AVE S, FARGO, ND 58104-5178
(701) 239-3700
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
06/14/2007
Last updated
07/08/2007
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