Individual
MICHAEL DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1528 5 PTS RD SW, ALBUQUERQUE, NM 87105-3179
(505) 242-6919
(505) 242-6929
Mailing address
1528 5 PTS RD SW, ALBUQUERQUE, NM 87105-3179
(505) 242-6919
(505) 242-6929
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0175921
NM
Other
Enumeration date
02/23/2018
Last updated
02/23/2018
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