Organization
PROFESSIONAL COUNSELING ASSOCIATES OF NEW MEXICO
Active
Other names
Greater Santa Rosa Council on Alcoholism
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RALPH L. MOYA I (CHIEF EXECUTIVE OFFICER)
(505) 461-3572
Entity
Organization
Contact information
Practice address
419 S 2ND ST, TUCUMCARI, NM 88401-2859
(505) 461-3572
Mailing address
419 S 2ND ST, TUCUMCARI, NM 88401-2859
(505) 461-3572
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LISW1041C0700X
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000A3588
—
NM
01
—
NM000217
VALUE OPTIONS
NM
Enumeration date
05/15/2007
Last updated
06/20/2008
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