Individual
MS. SANDRA CECELIA BODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CASE MANAGER
Contact information
Practice address
67 SUGAR LN, EL PRADO, NM 87529
(575) 770-2404
Mailing address
POB 2916, RANCHOS DE TAOS, NM 87557
(505) 770-2404
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
T-0096331
NM
Other
Enumeration date
05/17/2006
Last updated
01/22/2024
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