Individual
DEADRA D. CARRILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. LPC
Contact information
Practice address
333 ROAD 4990, BLOOMFIELD, NM 87413-9626
(505) 632-6713
Mailing address
333 ROAD 4990, BLOOMFIELD, NM 87413-9626
(505) 632-6713
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0510
NM
Other
Enumeration date
01/29/2007
Last updated
07/08/2007
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