Individual
KONAWHA D ADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
6333 E SKELLY DR, TULSA, OK 74135-6106
(918) 664-4224
Mailing address
6333 E SKELLY DR, TULSA, OK 74135-6106
(918) 664-4224
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
04/06/2009
Last updated
04/06/2009
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