Individual
LUANITA MARIE ETSITY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
HWY 491 NORTH PINON STREET, SHIPROCK, NM 87420-1830
(505) 368-1589
Mailing address
PO BOX 1830, SHIPROCK, NM 87420-1830
(505) 368-1589
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0092811
NM
Other
Enumeration date
07/18/2019
Last updated
07/18/2019
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