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Individual

VIRGINIA ESTALA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA, LAMFT

Contact information

Practice address
785 ANTHONY DRIVE, ANTHONY, NM 88021-2671
(575) 882-5100
(575) 882-1151
Mailing address
PO BOX 2671, ANTHONY, NM 88021-2671
(575) 882-5100
(575) 882-1151

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
CTL0199201
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
35650338
NM
Enumeration date
03/27/2017
Last updated
02/28/2019
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