Individual
KENNETH M. WANYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1528 FIVE POINTS RD SW, ALBUQUERQUE, NM 87105-3179
(505) 242-2696
Mailing address
1528 FIVE POINTS RD SW, ALBUQUERQUE, NM 87105-3179
(505) 242-2696
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0082931
NM
Other
Enumeration date
07/29/2020
Last updated
07/29/2020
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