Individual
SELENA EBONY MOYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSAA
Contact information
Practice address
1227 N RAILROAD AVE STE C, ESPANOLA, NM 87532-3159
(505) 747-8187
Mailing address
1227 N RAILROAD AVE STE C, ESPANOLA, NM 87532-3159
(505) 747-8187
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CTB-2022-0970
NM
Other
Enumeration date
12/05/2025
Last updated
12/05/2025
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