Individual
TRACY SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADAC
Contact information
Practice address
4100 BARBARA LOOP SE, RIO RANCHO, NM 87124-1000
(505) 702-8547
Mailing address
4100 BARBARA LOOP SE, RIO RANCHO, NM 87124-1000
(505) 702-8547
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0141901
NM
Other
Enumeration date
01/13/2017
Last updated
01/13/2017
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