Individual
MR. ERIC M. BANAGAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISW, LADAC
Contact information
Practice address
921 E 21ST ST, SUITE D, CLOVIS, NM 88101-4443
(575) 762-0212
(575) 762-0660
Mailing address
921 E 21ST ST, SUITE D, CLOVIS, NM 88101-4443
(575) 762-0212
(575) 762-0660
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0119781
NM
1041C0700X
Clinical Social Worker
Primary
I-06885
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13683527
—
NM
Enumeration date
07/13/2007
Last updated
05/15/2015
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