Healthcare Provider Details

I. General information

NPI: 1053459743
Provider Name (Legal Business Name): V. ARLINE HOAGLAND LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W COLLEGE AVE SUITE 7
SILVER CITY NM
88061-5002
US

IV. Provider business mailing address

4141 N SILVER ST
SILVER CITY NM
88061-7436
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-1880
  • Fax: 575-388-2284
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-05617
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: