Individual
CHARLES BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADAC
Contact information
Practice address
1441 S SAINT FRANCIS DR, SANTA FE, NM 87505-4037
(505) 982-2271
(505) 982-0620
Mailing address
617 JACKSON AVE APT B, GRANTS, NM 87020-2908
(505) 982-8870
(505) 982-0620
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0064141
NM
Other
Enumeration date
08/14/2007
Last updated
08/14/2007
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