Individual
MS. JOAN SOUTAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA LPC
Contact information
Practice address
620 5TH AVE, FAIRBANKS, AK 99701
(907) 474-0890
Mailing address
3281 EDBY RD, FAIRBANKS, AK 99709
(907) 474-0890
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
52
AK
Other
Enumeration date
02/07/2007
Last updated
07/08/2007
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