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1023154085
DEADRA D. CARRILLO
BLOOMFIELD, NM
NPI
1023154085
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: NM 0510)
Enumeration Date
2007-01-29
Last Update Date
2007-07-08
Business Address
-- DEADRA D. CARRILLO M.A. LPC
333 ROAD 4990
BLOOMFIELD, NM 87413-9626
Phone number: 505-632-6713
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Mailing Address
-- DEADRA D. CARRILLO M.A. LPC
333 ROAD 4990
BLOOMFIELD, NM 87413-9626
Phone number: 505-632-6713
Copy
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