Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
CHARLES L WALLACE, LADAC
ActiveCHARLES L WALLACE, LADAC is a Addiction (Substance Use Disorder) Counselor healthcare provider located in FARMINGTON, New Mexico. NPI 1902140932 is currently active in the NPPES registry. Verify at CMS.
Addiction (Substance Use Disorder) Counselor · FARMINGTON, NM
Registration Details
- NPI Number
- 1902140932
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Nov 15, 2012 (13.728232667479 yrs)
- Last Updated
- May 22, 2025
- License
-
3628 (NM)
Practice Information
- Address
-
653 W ARRINGTON STFARMINGTON, NM, 874018513Browse NM providers · Browse ZIP 87401
- Phone
- 5055643733
- Primary Specialty
-
Addiction (Substance Use Disorder) Counselor
101YA0400X
Other Addiction (Substance Use Disorder) Counselor Providers in FARMINGTON, NM
| Name | Credential | NPI |
|---|---|---|
| MS. JOLENE M. SCHNEIDER | LADAC | 1376563049 |
| KRISTA LEIGH RAINWATER | LPC | 1528150323 |
| ERNESTINE PLATERO | LSAA | 1710020300 |
| MARC S. BROADWAY | B.A., SAA | 1043342496 |
| MR. MARK SANCHEZ | LADAC,LCDC,ICADC,CAC | 1083735997 |
| TINA J JOHN | — | 1902013808 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.