Individual
MR. STEPHAN K. HANCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
72 GAIL HARRIS ST, ROSWELL, NM 88203-8116
(575) 347-3400
Mailing address
PO BOX 5664, ROSWELL, NM 88202-5664
(575) 590-7883
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0159701
NM
1041C0700X
Clinical Social Worker
Primary
M-08766
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
28858735
—
NM
Enumeration date
10/20/2016
Last updated
04/10/2017
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