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1265077275
JERRALD TOM JAMES
FARMINGTON, NM
NPI
1265077275
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: NM CAD0205831)
Enumeration Date
2019-11-13
Last Update Date
2019-11-13
Business Address
Mr. JERRALD TOM JAMES LADAC, LMSW
475 E 20TH ST STE D
FARMINGTON, NM 87401-2132
Phone number: 505-327-0293
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Mailing Address
Mr. JERRALD TOM JAMES LADAC, LMSW
475 E 20TH ST STE D
FARMINGTON, NM 87401-2132
Phone number: 505-327-0293
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