Individual
MILLICENT MUTISYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1115 N NORTH ST STE C, PEORIA, IL 61606-1959
(309) 839-8984
Mailing address
1801 WATERMARK DR, COLUMBUS, OH 43215-7088
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
02/20/2023
Last updated
02/20/2023
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