Individual
JUSTIN KONGOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4202 N I-10 SERVICE RD W., METAIRIE, LA 70006
(877) 418-2978
Mailing address
3818 JENA ST, NEW ORLEANS, LA 70125-4430
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
LA
Other
Enumeration date
12/24/2024
Last updated
12/24/2024
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