Individual
MARC S. BROADWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
B.A., SAA
Contact information
Practice address
2011 TROY KING RD TRLR 10, FARMINGTON, NM 87401-3123
(505) 566-0336
Mailing address
2011 TROY KING RD TRLR 10, FARMINGTON, NM 87401-3123
(505) 566-0336
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
4455
NM
Other
Enumeration date
03/12/2007
Last updated
07/08/2007
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