Individual
NICHOLE R MARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
785 ANTHONY DRIVE, ANTHONY, NM 88021
(575) 882-5100
(575) 882-1151
Mailing address
PO BOX 2671, ANTHONY, NM 88021-2671
(575) 882-5100
(575) 882-1151
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
X-10520
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35650338
—
NM
Enumeration date
06/19/2018
Last updated
06/19/2018
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