Healthcare Provider Details

I. General information

NPI: 1285279562
Provider Name (Legal Business Name): JARED SLOAN LADAC, CADAC, NCAC I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S DALMONT ST
HOBBS NM
88240-8428
US

IV. Provider business mailing address

PO BOX 5403
HOBBS NM
88241-5403
US

V. Phone/Fax

Practice location:
  • Phone: 575-391-1301
  • Fax: 575-391-1303
Mailing address:
  • Phone: 575-391-1301
  • Fax: 575-391-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0108681
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: