Individual
MS. MIGNON ELISSE MCNICOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
713 6TH ST, LAS VEGAS, NM 87701
(505) 429-0588
(505) 425-6236
Mailing address
713 6TH ST, LAS VEGAS, NM 87701
(505) 429-0588
(505) 425-6236
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I2153
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000F5787
—
NM
Enumeration date
12/05/2006
Last updated
07/08/2007
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