Healthcare Provider Details

I. General information

NPI: 1730417627
Provider Name (Legal Business Name): SHERRY LOU HETTIGER LPCC, LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N WHITE SANDS BLVD STE 112A
ALAMOGORDO NM
88310-6774
US

IV. Provider business mailing address

1200 N WHITE SANDS BLVD STE 112A
ALAMOGORDO NM
88310-6774
US

V. Phone/Fax

Practice location:
  • Phone: 575-491-3710
  • Fax: 575-415-3764
Mailing address:
  • Phone: 575-491-3710
  • Fax: 575-415-3764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number01177751
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0145441
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: