Provider Demographics
NPI:1205423829
Name:CHACON, JANICE (LCSW)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:CHACON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JANICE BALLIN
Mailing Address - Street 1:906 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6763
Mailing Address - Country:US
Mailing Address - Phone:575-415-4950
Mailing Address - Fax:575-377-8254
Practice Address - Street 1:700 1ST ST STE 707
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6500
Practice Address - Country:US
Practice Address - Phone:575-415-4950
Practice Address - Fax:575-377-8254
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-119531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical