Individual
NICOLE CAMILLE ARCHULETA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1227 N RAILROAD AVE STE C, ESPANOLA, NM 87532-3159
(505) 747-8187
Mailing address
1227 N RAILROAD AVE STE C, ESPANOLA, NM 87532-3159
(505) 747-8187
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0178081
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265683049
—
NM
Enumeration date
03/06/2018
Last updated
03/06/2018
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