Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 0120261 | NM |
NPI | 1003298142 |
---|---|
Provider Name | Robert Whiting |
First Address | Albuquerque, NM 87102-2355 |
Second Address | Albuquerque, NM 87102-2355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2015 |
Last Update Date | 25/06/2015 |