Individual
MS. CONSUELO CHRISTINA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSAA
Contact information
Practice address
650 VANDENBOSCH PKWY, GALLUP, NM 87301-5508
(505) 726-6919
Mailing address
650 VANDENBOSCH PKWY, GALLUP, NM 87301-5508
(505) 726-6919
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CSA0196801
NM
Other
Enumeration date
02/28/2020
Last updated
02/28/2020
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