Doctor Name: | JENNIFER P. VIGIL |
NPI Number: | 1194157271 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LADAC |
License Number: | 3503 |
Business Practice Address: | 1102 A Paseo De Onate Espanola, NM - 87533 |
Business Phone Number: | 5058521377 |
Business Fax Number: | |
Mailing Address: | Po Box 969, OHKAY OWINGEH |
State: | NM |
Postal Code: | 875660969 |
Phone Number: | 5058521377 |
Fax Number: | |
NPI Enumeration Date: | 07/31/2013 |
NPI Last Update Date: | 07/31/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 3503 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |