Healthcare Provider Details

I. General information

NPI: 1689773699
Provider Name (Legal Business Name): BRENDA LEE FRINK MA, LPCC, LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 JEFFERSON ST NE STE 300
ALBUQUERQUE NM
87109-4314
US

IV. Provider business mailing address

1612 LA CABRA CT SE
ALBUQUERQUE NM
87123-4468
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-1114
  • Fax:
Mailing address:
  • Phone: 505-507-1730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0067692
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0093471
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: