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Individual

CHRIS SIXTO MANZANARES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LADAC, LBSW

Contact information

Practice address
2301 7TH ST, LAS VEGAS, NM 87701-4966
(505) 454-9611
Mailing address
2301 7TH ST, LAS VEGAS, NM 87701-4966
(505) 454-9611

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
005707
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1194924928
NM
Enumeration date
03/01/2018
Last updated
03/01/2018
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