CLIFFORD JACK

FARMINGTON, NM
NPI1679078851
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: NM  0192461)
Enumeration Date2018-03-28
Last Update Date2018-03-28
Business Address
CLIFFORD JACK LSAA
511 E 20TH ST
FARMINGTON, NM 87401-2105
Phone number: 505-564-3733
Mailing Address
CLIFFORD JACK LSAA
511 E 20TH ST
FARMINGTON, NM 87401-2105
Phone number: 505-564-3733
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