Provider Demographics
NPI:1245734417
Name:COMTOIS, MARC (LCSW)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:COMTOIS
Suffix:
Gender:M
Credentials:LCSW
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 756
Mailing Address - Street 2:
Mailing Address - City:ANGEL FIRE
Mailing Address - State:NM
Mailing Address - Zip Code:87710-0756
Mailing Address - Country:US
Mailing Address - Phone:575-613-3361
Mailing Address - Fax:
Practice Address - Street 1:3465 MOUNTAIN VIEW BLVD
Practice Address - Street 2:SUITE 13
Practice Address - City:ANGEL FIRE
Practice Address - State:NM
Practice Address - Zip Code:87710-0756
Practice Address - Country:US
Practice Address - Phone:575-613-3361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-102491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical