Healthcare Provider Details

I. General information

NPI: 1376603373
Provider Name (Legal Business Name): MARIELA HISCOX LPCC LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4135 MONTGOMERY BLVD NE STE C
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

PO BOX 51957
ALBUQUERQUE NM
87181-1957
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-9393
  • Fax: 505-262-9393
Mailing address:
  • Phone: 505-262-9393
  • Fax: 505-262-9393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3769
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2518
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: