Individual
DR. MARY ELLEN AGOLIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
20 COTTAGE ROW, UNIT B, HIGH ROLLS MOUNTAIN PARK, NM 88325-9010
(575) 430-4115
(866) 561-1508
Mailing address
PO BOX 351, HIGH ROLLS MOUNTAIN PARK, NM 88325-0351
(575) 430-4115
(866) 561-1508
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1188
NM
104100000X
Social Worker
M0432
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
N3745
—
NM
Enumeration date
11/14/2006
Last updated
03/21/2021
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