Individual
THERESA J. PAUL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADAC
Contact information
Practice address
HWY 491 N. PINON ST., SHIPROCK, NM 87420-1830
(505) 368-1438
(505) 368-1452
Mailing address
PO BOX 1830, SHIPROCK, NM 87420-1830
(505) 368-1438
(505) 368-1452
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0178601
NM
Other
Enumeration date
04/07/2017
Last updated
07/09/2019
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