Individual
MASSA CHINISEGAL YAMBA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
175 WILLARD ST APT 7, LOWELL, MA 01850-1374
(978) 494-9243
Mailing address
175 WILLARD ST APT 7, LOWELL, MA 01850-1374
(978) 494-9243
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ISSUER
—
MA
Enumeration date
03/02/2018
Last updated
06/16/2018
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