Individual
MARY R. GOMEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADAC
Contact information
Practice address
1611 CENTRAL AVE. NW, ALBUQ, NM 87104
(505) 247-4622
(505) 247-1373
Mailing address
1611 CENTRAL AVE NW, ALBUQUERQUE, NM 87104-1139
(505) 247-4622
(505) 247-1373
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3678
NM
Other
Enumeration date
07/12/2013
Last updated
07/12/2013
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