Individual
THEODORE WYATT MOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L. P. C.
Contact information
Practice address
35037 ROYAL PL, SOLDOTNA, AK 99669-9755
(907) 260-7423
Mailing address
48405 BERNICE AVE, SOLDOTNA, AK 99669-9437
(907) 953-1103
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
736
AK
Other
Enumeration date
03/19/2012
Last updated
03/19/2012
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