Individual
CARRIE LUCINDA FORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 W BROADWAY STE D, FARMINGTON, NM 87401-5638
(505) 325-0238
Mailing address
1001 W. BROADWAY SUITE D, FARMINGTON, NM 87401
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/09/2017
Last updated
04/27/2018
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