Organization
AMY DONDANVILLE LCSW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
APRIL BANCROFT CREDENTIALING (DIR OF OPERATIONS)
(505) 384-7352
Entity
Organization
Contact information
Practice address
522 PASEO DEL PUEBLO NORTE, TAOS, NM 87571-5908
(575) 224-2710
Mailing address
PO BOX 537, TAOS, NM 87571-0537
(575) 224-2710
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1245606649
TYPE 1 NPI
NM
Enumeration date
04/24/2019
Last updated
07/05/2019
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