Individual
MS. ELIZABETH MBULA WASONGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC-S
Contact information
Practice address
828 CHIEF EDDIE HOFFMAN HWY, BETHEL, AK 99559-0528
(907) 543-6100
(907) 543-6159
Mailing address
4102 GREENWOOD WAY, MANSFIELD, TX 76063
(682) 422-3909
(682) 422-3909
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
20115
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020986
—
AK
05
—
193427501
—
TX
01
—
88601L
BLUECROSSBLUESHIELD PROV#
TX
Enumeration date
02/19/2008
Last updated
12/01/2020
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