Provider Demographics
NPI:1053529636
Name:JOE, RITA (CAD, LADAC, CACIII,)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:JOE
Suffix:
Gender:F
Credentials:CAD, LADAC, CACIII,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:
Mailing Address - City:TOWAOC
Mailing Address - State:CO
Mailing Address - Zip Code:81334-0273
Mailing Address - Country:US
Mailing Address - Phone:970-560-2414
Mailing Address - Fax:505-368-1467
Practice Address - Street 1:PINON & COTTONWOOD DR BUILDING #2301
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420
Practice Address - Country:US
Practice Address - Phone:505-368-1438
Practice Address - Fax:505-368-1461
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1864101YA0400X
AZ17315101YA0400X
AZRRNN32101YA0400X
NM3955101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)