Individual
LISA A MCTAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMSW
Contact information
Practice address
2551 COORS BLVD NW, ALBUQUERQUE, NM 87120-1213
(505) 338-3320
Mailing address
2551 COORS BLVD NW, ALBUQUERQUE, NM 87120-1213
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M-08387
NM
1041C0700X
Clinical Social Worker
X-08111
NM
Other
Enumeration date
05/23/2013
Last updated
02/05/2015
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