Individual
MR. STEPHEN CHRISTPHER MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSAA
Contact information
Practice address
413 SIPAPU RD, TAOS, NM 87571
(505) 758-5857
(505) 758-2832
Mailing address
7320 NDCBU, TAOS, NM 87571
(505) 751-4536
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
005761
NM
Other
Enumeration date
05/16/2006
Last updated
03/19/2015
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