Individual
MAKAYLA KRISTEN JOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1107 S ATKINSON AVE, ROSWELL, NM 88203-7154
(575) 578-4826
(575) 578-4828
Mailing address
1107 S ATKINSON AVE, ROSWELL, NM 88203-7154
(575) 578-4826
(575) 578-4828
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CSA0217981
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CSA0217981
—
NM
Enumeration date
08/02/2021
Last updated
08/02/2021
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