Individual
EMERSON CHARLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSAA
Contact information
Practice address
2105 HASLER VALLEY RD, GALLUP, NM 87301-8730
(505) 471-4985
Mailing address
2504 CAMINO ENTRADA, SANTA FE, NM 87507-4851
(505) 471-4985
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CSA0209321
NM
Other
Enumeration date
03/08/2016
Last updated
11/01/2023
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