Individual
CARLOS GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADAC
Contact information
Practice address
2000 SAINT MICHAELS DR STE 5, SANTA FE, NM 87505-7630
(505) 699-3488
Mailing address
PO BOX 4144, SANTA FE, NM 87502-4144
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0189851
NM
Other
Enumeration date
06/22/2017
Last updated
06/22/2017
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