Individual
ELIZABETH EVERSOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11401 MENAUL BLVD NE, ALBUQUERQUE, NM 87112-2435
(505) 526-3649
Mailing address
300 MENAUL BLVD NW STE A, ALBUQUERQUE, NM 87107-1347
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CSA0216751
NM
Other
Enumeration date
09/29/2021
Last updated
08/08/2023
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