Individual provider · Type 1 NPI

Charles L. Wallace, LADAC

Addiction (Substance Use Disorder) Counselor · Farmington, NM

NPI number 1902140932 Active

Practice location

653 W Arrington St
Farmington, NM 87401-8513

Call (505) 564-3733 Map

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400X3628 (NM)

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1902140932

Charles L. Wallace, LADAC's National Provider Identifier is 1902140932, issued on Nov 15, 2012. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Farmington, NM. The record was last updated on May 22, 2025.