| NPI | 1215254909 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLTON W LEWIS Manager 505-259-9100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 0122291) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 0092471) |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2010-04-21 |