CHARLES L WALLACE

FARMINGTON, NM
NPI1902140932
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: NM  3628)
Enumeration Date2012-11-15
Last Update Date2025-05-22
Business Address
CHARLES L WALLACE LADAC
653 W ARRINGTON ST
FARMINGTON, NM 87401-8513
Phone number: 505-564-3733
Mailing Address
CHARLES L WALLACE LADAC
653 W ARRINGTON ST
FARMINGTON, NM 87401-8513
Phone number: 505-564-3733
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