Individual
LAURIE MAE GRANT DESILVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5312 JAGUAR DR, SANTA FE, NM 87507-1827
(505) 471-5006
Mailing address
5312 JAGUAR DR, SANTA FE, NM 87507-1827
(505) 471-5006
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
T -0107501
NM
Other
Enumeration date
10/02/2007
Last updated
10/02/2007
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