Individual
MS. ROBIN LEE WOOLLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISW, LADAC
Contact information
Practice address
615 E LINCOLN ST, LAS VEGAS, NM 87701-4502
(719) 680-9680
Mailing address
PO BOX 162, 201 RAILROAD AVE., WAGON MOUND, NM 87752-0162
(719) 680-9680
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0092671
NM
1041C0700X
Clinical Social Worker
Primary
I-2696
NM
1041C0700X
Clinical Social Worker
LCSW-1129
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104449
VALUE OPTIONS MEDICAID PROVIDER
NM
Enumeration date
09/09/2008
Last updated
09/09/2008
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