Individual
MR. LORENZO R JIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADAC
Contact information
Practice address
5608 ZUNI RD SE, ALBUQUERQUE, NM 87108-2926
(505) 262-2481
(505) 265-7045
Mailing address
5608 ZUNI RD SE, ALBUQUERQUE, NM 87108-2926
(505) 262-2481
(505) 265-7045
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0125371
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0125371
STATE LICENSE
NM
Enumeration date
09/10/2009
Last updated
09/10/2009
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