Individual
MRS. TISHA PETELO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, MAC
Contact information
Practice address
FIATELE TEO BLDG., AIRPORT ROAD 1005, PAGO PAGO, AS 96799-1005
(684) 699-3725
Mailing address
PO BOX 1005, PAGO PAGO, AS 96799-1005
(684) 699-3725
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
809
CO
Other
Enumeration date
10/22/2009
Last updated
10/22/2009
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