Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CSA0221211 | NM |
NPI | 1003572116 |
---|---|
Provider Name | Paul Dubois |
First Address | Albuquerque, NM 87109-3155 |
Second Address | Albuquerque, NM 87109-3155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2021 |
Last Update Date | 12/11/2021 |