Individual
AQUILES MOUTHON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CASAC-T
Contact information
Practice address
3114 30TH AVE, 2ND FLOOR, ASTORIA, NY 11102-1530
(718) 204-1200
(718) 204-1276
Mailing address
3114 30TH AVE, 2ND FLOOR, ASTORIA, NY 11102-1530
(718) 204-1200
(718) 204-1276
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
28649
NY
Other
Enumeration date
07/30/2015
Last updated
07/30/2015
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