Individual
DAVID VAN AUSDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 1ST ST NW STE 200, ALBUQUERQUE, NM 87102-2311
(505) 224-9124
Mailing address
400 GOLD AVE SW STE 1200, ALBUQUERQUE, NM 87102-3276
(505) 224-9124
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CSA0223681
NM
104100000X
Social Worker
SWB-2024-0962
NM
Other
Enumeration date
04/29/2022
Last updated
12/06/2024
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