Individual
MR. MICHAEL A. NINNESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
854 LOST CREEK LN, WASHINGTON, MO 63090-5492
(636) 390-3261
Mailing address
854 LOST CREEK LN, WASHINGTON, MO 63090-5492
(636) 390-3261
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3788
MO
Other
Enumeration date
06/08/2009
Last updated
06/08/2009
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