Individual
JANNELIS I MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1985 MAIN ST STE 305, SPRINGFIELD, MA 01103-1074
(413) 885-3965
Mailing address
1985 MAIN ST STE 305, SPRINGFIELD, MA 01103-1074
(413) 885-3965
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
09/12/2022
Last updated
09/12/2022
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