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ANGELICA DEIDRE MEDINA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CCSW

Contact information

Practice address
2573 STATE HIGHWAY 522, QUESTA, NM 87556
(575) 586-0315
Mailing address
PO BOX 2267, SANTA FE, NM 87504-2267
(505) 296-8292

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Enumeration date
06/09/2011
Last updated
03/06/2017
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