Individual
LIESA PAVOGGI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
265 ACORN LN, KILLEEN, TX 76542-5001
(254) 781-6288
Mailing address
265 ACORN LN, KILLEEN, TX 76542-5001
(254) 781-6288
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
71045
TX
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12300
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487913711
UNITED STATES ARMY
TX
Enumeration date
12/16/2015
Last updated
12/16/2015
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