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General NPI Number Information
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NPI Number | 1053529636
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Entity Type | Individual
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Provider Name | RITA JOE C.AD, LADAC, CACIII,
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Gender | Female
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 09/20/2019
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Provider Practice Location Address
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Address Line | PINON & COTTONWOOD DR BUILDING #2301
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City | SHIPROCK
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State | NM
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Zip | 87420
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Country | US
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Telephone | 505-368-1438
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Fax | 505-368-1461
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Provider Business Mailing Address
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Address Line | PO BOX 273
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City | TOWAOC
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State | CO
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Zip | 81334-0273
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Country | US
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Telephone | 970-560-2414
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Fax | 505-368-1467
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1864
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 17315
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | RRNN32
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 3955
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License Number State | NM
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