Individual
GINA STORK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
3662 GARBER AVE, LAKE CITY, IA 51449-7554
(712) 790-9318
Mailing address
3662 GARBER AVE, LAKE CITY, IA 51449-7554
(712) 790-9318
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
001715
IA
Other
Enumeration date
03/27/2014
Last updated
03/27/2014
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