Healthcare Provider Details

I. General information

NPI: 1447710199
Provider Name (Legal Business Name): AMANDA NICOLE HANSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5640 VENICE AVE NE
ALBUQUERQUE NM
87113-2350
US

IV. Provider business mailing address

1609 JOHN ST SE
ALBUQUERQUE NM
87102-4735
US

V. Phone/Fax

Practice location:
  • Phone: 505-408-4280
  • Fax:
Mailing address:
  • Phone: 505-717-7280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2025-0643
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: