Individual
ALYSE Y MOULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1900 RANDOLPH RD SE, ALBUQUERQUE, NM 87106-4247
(505) 750-4547
Mailing address
1321 E POPLAR ST, DEMING, NM 88030-4807
(575) 546-5951
(575) 546-5994
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SWB-2022-0251
NM
Other
Enumeration date
09/12/2022
Last updated
09/12/2022
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