Individual
ALTA MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
216 W MALONEY AVE, GALLUP, NM 87301-5214
(505) 879-5656
Mailing address
PO BOX 251, FORT WINGATE, NM 87316-0251
(505) 879-5656
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0071741
NM
Other
Enumeration date
02/16/2018
Last updated
02/16/2018
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