Healthcare Provider Details

I. General information

NPI: 1609349307
Provider Name (Legal Business Name): ALEXANDRA WOFFORD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 CUBA AVE STE 5
ALAMOGORDO NM
88310-5646
US

IV. Provider business mailing address

122 HIGHWAY 82
ALAMOGORDO NM
88310-9787
US

V. Phone/Fax

Practice location:
  • Phone: 575-439-7469
  • Fax: 575-489-4619
Mailing address:
  • Phone: 575-491-8188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRA WOFFORD
Title or Position: LPCC
Credential:
Phone: 575-439-7469