Individual
MR. CLARENCE WILFRED GODDARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA LADAC
Contact information
Practice address
807 CALLE CHAMISAL, ESPANOLA, NM 87532-2976
(505) 372-4511
Mailing address
PO BOX 1775, ESPANOLA, NM 87532-1775
(505) 423-4617
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CAD0210951
NM
Other
Enumeration date
10/31/2022
Last updated
10/31/2022
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