Theodore Gongola

NPI #1053656108 in Russellville, Arkansas

Provider Information

NPI Number: 1053656108
Entity Type: Individual
Name: Theodore Gongola
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor
Enumeration Date: Nov 30, 2012
Last Updated: Nov 30, 2012

Practice Location

Address: 3205 W MAIN ST
City: Russellville
State: Arkansas
ZIP Code: 72801-2301
Phone: (479) 967-4673

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X	Primary

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