Provider Demographics
NPI:1518106814
Name:RAABE, WILLIAM WALLACE II (LADAC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:WALLACE
Last Name:RAABE
Suffix:II
Gender:M
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 W COLLEGE LN
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88242-9126
Mailing Address - Country:US
Mailing Address - Phone:575-392-2231
Mailing Address - Fax:575-392-6484
Practice Address - Street 1:3821 W COLLEGE LN
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88242-9126
Practice Address - Country:US
Practice Address - Phone:575-392-2231
Practice Address - Fax:575-392-6484
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0103031101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM800521083OtherMEDICARE GROUP NUMBER
NM000463000Medicaid