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1760563001
BEN GRAYWOLF
ALBUQUERQUE, NM
NPI
1760563001
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: NM OO79341)
Enumeration Date
2006-10-17
Last Update Date
2007-07-08
Business Address
Mr. BEN GRAYWOLF
1217 1ST ST NW
ALBUQUERQUE, NM 87102-1529
Phone number: 505-344-6738
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Mailing Address
Mr. BEN GRAYWOLF
1111 CARDENAS DR SE APT # 316
ALBUQUERQUE, NM 87108-4736
Phone number: 505-338-8027
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