Individual
ALISHA O'DONOVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1390 S ROOSEVELT ROAD 30, ROGERS, NM 88132-9724
(575) 602-2721
Mailing address
1390 S ROOSEVELT ROAD 30, ROGERS, NM 88132-9724
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CMH0196111
NM
Other
Enumeration date
09/24/2019
Last updated
09/24/2019
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