Healthcare Provider Details

I. General information

NPI: 1982183695
Provider Name (Legal Business Name): ALEXANDRA WOFFORD LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 12/10/2018
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: 575-491-8188
  • Fax:
Mailing address:
  • Phone: 575-491-8188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0200901
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: