Individual
AMANDA CLEARWATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADAC
Contact information
Practice address
663 HAMPTON CANYON RD, AZTEC, NM 87410-1007
(505) 217-6834
Mailing address
663 HAMPTON CANYON RD, AZTEC, NM 87410-1007
(505) 217-6834
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0178391
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60903082
—
NM
Enumeration date
01/05/2016
Last updated
07/10/2025
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