Individual
CORINE JOHN-DODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSAA
Contact information
Practice address
607 E APACHE ST, FARMINGTON, NM 87401-6925
(505) 326-2012
(505) 326-2939
Mailing address
607 E APACHE ST, FARMINGTON, NM 87401-6925
(505) 326-2012
(505) 326-2939
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0156181
NM
Other
Enumeration date
02/23/2018
Last updated
02/23/2018
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