Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 8096 | PA |
NPI | 1003418815 |
---|---|
Provider Name | Michael A Mieczkowski |
First Address | Vero Beach, FL 32967-2473 |
Second Address | Vero Beach, FL 32967-2473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2020 |
Last Update Date | 16/11/2020 |