Individual
CHUCK IVY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1407 HIGHLAND RD, ROSWELL, NM 88201-2146
(575) 208-2918
(575) 208-2918
Mailing address
1407 HIGHLAND RD, ROSWELL, NM 88201-2146
(575) 208-2918
(575) 208-2918
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-10013
NM
Other
Enumeration date
05/12/2010
Last updated
03/05/2021
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