Individual
LISA M PANICOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7400 HIGHWAY N, DARDENNE PRAIRIE, MO 63368-7013
(636) 561-7080
Mailing address
6626 MARDEL AVE, SAINT LOUIS, MO 63109-1226
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2006036530
MO
Other
Enumeration date
04/20/2007
Last updated
07/08/2007
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