Individual
CHARLES MACNEILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BMS
Contact information
Practice address
118 ESTE ES RD STE H, TAOS, NM 87571-6638
(575) 758-7263
Mailing address
PO BOX 28220, SANTA FE, NM 87592-8220
(505) 471-5006
(505) 820-9220
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/01/2009
Last updated
09/01/2009
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