Individual
AMANDA CAROLINE ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSAA
Contact information
Practice address
214 W BROADWAY ST, SILVER CITY, NM 88061-5353
(575) 654-5568
Mailing address
PO BOX 1477, BAYARD, NM 88023-1477
(575) 654-5568
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CSA0201351
NM
Other
Enumeration date
12/26/2018
Last updated
12/26/2018
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