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Individual

MS. ANNIE C VILLANUEVA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LSAA

Contact information

Practice address
123 MADEIRA DRIVE SE, ALBUQUERQUE, NM 87108-2963
(505) 262-1538
(505) 243-5342
Mailing address
123 MADEIRA DRIVE SE, ALBUQUERQUE, NM 87108-2963
(505) 262-1538
(505) 243-5342

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0065202
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0065202
METHADONE PROVIDER
NM
Enumeration date
10/02/2012
Last updated
10/02/2012
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