Individual
ROBERT E MAITLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSAA
Contact information
Practice address
105 W GRIGGS AVE, LAS CRUCES, NM 88001
(575) 647-2800
(575) 647-2898
Mailing address
385 CALLE DE ALEGRA STE A, LAS CRUCES, NM 88005-3423
(575) 526-1105
(575) 524-4266
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CSA0189151
NM
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31071350
—
NM
Enumeration date
09/26/2017
Last updated
01/20/2020
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