Individual
CHARLES ALEXANDER HUYCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
Mailing address
PO BOX 1337, GALLUP, NM 87305-1337
(505) 722-1000
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1-01485
MI
104100000X
Social Worker
6801070632
MI
1041C0700X
Clinical Social Worker
06511
IA
1041C0700X
Clinical Social Worker
Primary
6801-070632
MI
Other
Enumeration date
05/23/2007
Last updated
04/23/2015
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