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General NPI Number Information
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NPI Number | 1245635309
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Entity Type | Individual
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Provider Name | DONNA ENFIELD MSW
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Gender | Female
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | EXIT 102 1/2 MI S OF I-40
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City | SAN FIDEL
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State | NM
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Zip | 87049
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Country | US
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Telephone | 505-552-5317
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 130
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City | SAN FIDEL
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State | NM
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Zip | 87049-0130
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Country | US
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Telephone | 505-552-5317
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | X-08924
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License Number State | NM
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