Individual
AMADA N/A HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CAC III
Contact information
Practice address
711 BARNES AVE, LA JUNTA, CO 81050-2138
(719) 336-6931
(719) 336-0478
Mailing address
PO BOX 4, BRISTOL, CO 81047-0004
(719) 691-1635
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
7218
CO
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
7242
CO
Other
Enumeration date
01/12/2011
Last updated
12/19/2012
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