Healthcare Provider Details

I. General information

NPI: 1558357772
Provider Name (Legal Business Name): SONDRA M REDWOOD LPCC LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GRACELAND SE SUITE A
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

PO BOX 4339
ALBUQUERQUE NM
87106
US

V. Phone/Fax

Practice location:
  • Phone: 505-261-0952
  • Fax: 505-261-0952
Mailing address:
  • Phone: 505-261-0952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3591
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0851
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: