Individual
YANNICK MALCOLM STALLWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1709 BRAGAW ST, ANCHORAGE, AK 99508-3436
(907) 290-4773
Mailing address
1520 ELCADORE DR APT 133, ANCHORAGE, AK 99507-4750
(907) 290-4773
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/09/2020
Last updated
09/09/2020
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