Individual
MADISON MARY MITOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
467 COOPERS HAWK DR, SUMMERVILLE, SC 29483-8208
(631) 796-6249
Mailing address
467 COOPERS HAWK DR, SUMMERVILLE, SC 29483-8208
(631) 796-6249
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
14004
SC
Other
Enumeration date
02/12/2021
Last updated
02/12/2021
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