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Individual

MRS. JENNIFER JOHN CHARLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LADAC

Contact information

Practice address
15 BEHAVIORAL HEALTH RD, PINEHILL, NM 87357
(505) 775-3353
(505) 775-3630
Mailing address
PO BOX 490, PINEHILL, NM 87357-0490
(505) 775-3353
(505) 775-3630

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0119271
NM

Other

Enumeration date
04/11/2016
Last updated
04/11/2016
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