Individual
MR. MARK DISBROW JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IADC
Contact information
Practice address
3601 16TH AVE SW, CEDAR RAPIDS, IA 52404-2328
(319) 390-4611
Mailing address
11016 218TH AVE, COLUMBUS JUNCTION, IA 52738-9166
(417) 664-3454
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
7379
MO
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7379
MISSOURI CREDENTIALING BOARD
MO
Enumeration date
03/18/2020
Last updated
03/18/2020
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