Healthcare Provider Details

I. General information

NPI: 1427393842
Provider Name (Legal Business Name): SARAH MICHELLE WYNNE MA, LPCC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 CANDELARIA RD NE STE 113
ALBUQUERQUE NM
87107-1969
US

IV. Provider business mailing address

501 49TH ST NW
ALBUQUERQUE NM
87105-1621
US

V. Phone/Fax

Practice location:
  • Phone: 505-980-5932
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0197821
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: