Individual
MS. JEANETTE VICE TOLEDO VICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSAA
Contact information
Practice address
HC 79 BOX 1510, OJO ENCINO, NM 87013-9612
(505) 731-1500
(505) 731-1502
Mailing address
HC 79 BOX 1508, OJO ENCINO, NM 87013-9612
(505) 731-1505
(505) 731-1502
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
070481
NM
Other
Enumeration date
02/08/2012
Last updated
02/08/2012
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