Individual
DEMICA RENEA REAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1709 MOON ST NE, ALBUQUERQUE, NM 87112-3935
(505) 271-0329
Mailing address
5340 SAN MATEO BLVD NE, E53, ALBUQUERQUE, NM 87109-6268
(254) 768-1054
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
03/16/2018
Last updated
03/16/2018
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