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Individual

MS. LISA MARIE KING

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA,LADAC

Contact information

Practice address
86 MEDICINE HORSE DR., 86 MEDICINE HORSE DR., CANONCITO, NM 87026
(505) 908-2571
Mailing address
86 MEDICINE HORSE DR., 86 MEDICINE HORSE DR., CANONCITO, NM 87026-3368
(505) 908-2571

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0131581
NM
101YA0400X
Addiction (Substance Use Disorder) Counselor
702824
NM

Other

Enumeration date
08/11/2010
Last updated
10/26/2015
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