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Individual

MR. JERRALD TOM JAMES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LADAC, LMSW

Contact information

Practice address
475 E 20TH ST STE D, FARMINGTON, NM 87401-2132
(505) 327-0293
(505) 564-4925
Mailing address
475 E 20TH ST STE D, FARMINGTON, NM 87401-2132
(505) 327-0293
(505) 564-4925

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CAD0205831
NM

Other

Enumeration date
11/13/2019
Last updated
11/13/2019
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