Healthcare Provider Details

I. General information

NPI: 1548840069
Provider Name (Legal Business Name): ERIC JOSEPH VALENCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N WEST ST
SILVER CITY NM
88061-4600
US

IV. Provider business mailing address

713 N CORBIN ST
SILVER CITY NM
88061-6309
US

V. Phone/Fax

Practice location:
  • Phone: 575-654-0576
  • Fax:
Mailing address:
  • Phone: 575-590-5037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: