Individual
SUSIE KATHERINE MITKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1521 S CUSHMAN ST, FAIRBANKS, AK 99701-6203
(907) 452-8251
(907) 459-3842
Mailing address
1521 S CUSHMAN ST, FAIRBANKS, AK 99701-6203
(907) 452-8251
(907) 459-3842
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5191621
DRIVER'S LICENSE
AK
Enumeration date
07/08/2022
Last updated
07/08/2022
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