Organization
AT HOME GERIATRIC COUNSELING AND CONSULTATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROXROY ANTHONY REID LISW (OWNER)
(505) 710-4278
Entity
Organization
Contact information
Practice address
25 CAMINO COLLADO, EDGEWOOD, NM 87015-9788
(505) 710-4278
(505) 407-4848
Mailing address
25 CAMINO COLLADO, EDGEWOOD, NM 87015-9788
(505) 710-4278
(505) 407-4848
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
I-06926
NM
251B00000X
Case Management Agency
Primary
I-06926
NM
Other
Enumeration date
09/10/2012
Last updated
09/10/2012
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