Individual
MR. BEN GRAYWOLF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1217 1ST ST NW, ALBUQUERQUE, NM 87102-1529
(505) 344-6738
(505) 344-1862
Mailing address
1111 CARDENAS DR SE, APT # 316, ALBUQUERQUE, NM 87108-4736
(505) 338-8027
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
OO79341
NM
Other
Enumeration date
10/17/2006
Last updated
07/08/2007
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