person
Charles L Wallace, LADAC
Addiction (Substance Use Disorder) Counselor in Farmington, New Mexico
NPI 1902140932

Charles L Wallace is an Addiction (Substance Use Disorder) Counselor based in Farmington, NM and is specialized in Addiction (Substance Use Disorder). Charles L Wallace practices in Farmington, NM and has the professional credentials of LADAC. The NPI Number for Charles L Wallace is 1902140932 and holds a License No. 3628 (New Mexico).

The current practice location address for Charles L Wallace is 2901 E. 20Th Suite 104, Farmington, NM and can be reached out via phone at 505-326-0241 and via fax at 505-325-8356.

Location: 2901 E. 20Th Suite 104, Farmington, NM, 87499
person
Provider Profile Details
NPI Number
1902140932
Provider Name
Charles L Wallace
Credential
LADAC
Provider Entity Type
Individual
Gender
Male
Address
2901 E. 20Th Suite 104, Farmington, NM, 87499
Phone Number
505-326-0241
Fax Number
505-325-8356
Provider Enumeration Date
11/15/2012
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
2901 E. 20Th Suite 104
City
State
Zip
87499
Phone Number
505-326-0241
Fax Number
505-325-8356
person
Provider Business Mailing Address Details
Address
2901 E. 20Th Suite 104
City
State
Zip
87499
Phone Number
505-326-0241
Fax Number
505-325-8356
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
3628 (New Mexico)
Definition
Definition to come...
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