Individual
MR. ETTIENE EDEMIDIONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4200 N MERIDIAN AVE, APT 433, OKLAHOMA CITY, OK 73112-2628
(281) 740-5572
Mailing address
4200 N MERIDIAN AVE, APT 433, OKLAHOMA CITY, OK 73112-2628
(281) 740-5572
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/07/2015
Last updated
06/07/2015
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