Individual
MS. MARY E BENALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADAC, LISAC
Contact information
Practice address
HWY 491 N., PINON ST., SHIPROCK, NM 87420
(505) 368-1050
(505) 368-1055
Mailing address
PO BOX 102, WATERFLOW, NM 87421-0102
(505) 368-1050
(505) 368-1055
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11490
AZ
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3814
NM
Other
Enumeration date
05/17/2007
Last updated
07/08/2007
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