Provider Demographics
NPI:1801169909
Name:HOPKIN, MICHAEL J (LADAC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:HOPKIN
Suffix:
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 1:1208 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4916
Mailing Address - Country:US
Mailing Address - Phone:575-551-6963
Mailing Address - Fax:
Practice Address - Street 1:1208 MAPLE DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4916
Practice Address - Country:US
Practice Address - Phone:575-551-6963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0147041101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)