Individual
MS. CONSTANCE SOPHIA AMIDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
410 CORTEZ PLACE, SANTA FE, NM 87501-2440
(505) 660-7293
Mailing address
410 CORTEZ PLACE, SANTA FE, NM 87501-2440
(505) 660-7293
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1190
NM
Other
Enumeration date
05/30/2007
Last updated
07/08/2007
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