Individual
MRS. ELIZABETH ANN DETWILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC-T
Contact information
Practice address
28 BALATON AVE, RONKONKOMA, NY 11779-1702
(631) 580-7777
(631) 580-7773
Mailing address
28 BALATON AVE, RONKONKOMA, NY 11779-1702
(631) 580-7777
(631) 580-7773
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T 20296
NY
Other
Enumeration date
06/08/2011
Last updated
06/08/2011
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