MR. CLARENCE WILFRED GODDARD MA LADAC
NPI 1215644141
Counselor - Addiction (Substance Use Disorder) in Espanola, NM
Active since October 31, 2022
About Mr. Clarence Wilfred Goddard Ma Ladac NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MR. CLARENCE WILFRED GODDARD MA LADAC (NPI 1215644141) is an individual addiction (substance use disorder) provider in Espanola, New Mexico, licensed in New Mexico (CAD0210951) and active in the NPI registry since October 2022.
NPPES Registry Identity
NPI1215644141
Entity TypeIndividualMale
Primary Taxonomy101YA0400X
Provider Legal NameMR. CLARENCE WILFRED GODDARDCredential: MA LADAC
Location Address807 CALLE CHAMISALEspanola, NM 87532-2976
Mailing AddressPo Box 1775Espanola, NM 87532-1775 · (505) 423-4617
Phone(505) 372-4511
Sole ProprietorNo
Enumeration DateOctober 31, 2022
NPPES CertifiedOctober 31, 2022
✔ NPI 1215644141 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
License✔ Licensed in NM · CAD0210951
807 CALLE CHAMISAL, Espanola, NM 87532
Other Providers at the Same Location NPPES 18
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Clinic/Center (Mental Health (Including Community Mental Health Center))
807 CALLE CHAMISAL
ESPANOLA, NM 87532
ESPANOLA, NM 87532
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1215644141, enumerated as an "individual" on October 31, 2022.
The provider is located at 807 CALLE CHAMISAL ESPANOLA, NM 87532 and the phone number is (505) 372-4511.
Counselor with taxonomy code 101YA0400X and a focus in Addiction (Substance Use Disorder).
