Individual
MARY JANE DYKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
428 MARR ST, TRUTH OR CONSEQUENCES, NM 87901-3381
(575) 894-0043
Mailing address
310 N BROADWAY ST, TRUTH OR CONSEQUENCES, NM 87901-2834
(575) 297-0171
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
M09548
NM
1041C0700X
Clinical Social Worker
Primary
C-10591
NM
Other
Enumeration date
07/26/2016
Last updated
11/28/2018
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