Individual
ATHENA MARIE GASSOUMIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.DIV., LADAC
Contact information
Practice address
119 COURT ST, POB 876, SOCORRO, NM 87801-4505
(575) 835-2389
Mailing address
115-119 COURT STREET, P.O.BOX 876, SOCORRO, NM 87801
(575) 835-2389
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0087871
NM
Other
Enumeration date
03/31/2011
Last updated
03/31/2011
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