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Theodore Gongola
Counselor in Russellville, Arkansas
NPI 1053656108

Theodore Gongola is a Counselor based in Bentonville, AR. Theodore Gongola practices in Russellville, AR. The NPI Number for Theodore Gongola is 1053656108 and holds a License No. (Arkansas).

The current practice location address for Theodore Gongola is 3205 W Main St, Russellville, AR and can be reached out via phone at 479-967-4673 and via fax at 479-967-7140.

Location: 3205 W Main St, Russellville, AR, 72712-4576
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1053656108
Provider Name
Theodore Gongola
Credential
Provider Entity Type
Individual
Gender
Male
Address
3205 W Main St, Russellville, AR, 72712-4576
Phone Number
479-967-4673
Fax Number
479-967-7140
Provider Enumeration Date
11/30/2012
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
3205 W Main St
City
Russellville
State
Arkansas
Zip
72801-2301
Phone Number
479-967-4673
Fax Number
479-967-7140
person
Provider Business Mailing Address Details
Address
3205 W Main St
City
Russellville
State
Arkansas
Zip
72801-2301
Phone Number
479-967-4673
Fax Number
479-967-7140
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
-
Taxonomy
101Y00000X
License No.
()
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
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