Organization
USA MEDDAC, RWBACH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH A BUBALA LCSW, LISAC (CLINICAL DIRECTOR, ASAP)
(520) 533-2071
Entity
Organization
Contact information
Practice address
2240 WINROW AVE, FORT HUACHUCA, AZ 85613
(520) 533-2071
Mailing address
2240 WINROW AVE, FORT HUACHUCA, AZ 85613
(520) 533-2071
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
LCSW 0611
AZ
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
LISAC 1029
AZ
Other
Enumeration date
10/25/2006
Last updated
07/19/2007
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