Individual
SHARON A. GRADY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
239 S 4TH ST, SANTA ROSA, NM 88435-2322
(575) 472-5073
Mailing address
PO BOX 506, SANTA ROSA, NM 88435-0506
(505) 795-2681
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0114921
NM
101YP2500X
Professional Counselor
Primary
0143121
NM
Other
Enumeration date
08/26/2008
Last updated
10/08/2011
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