Healthcare Provider Details

I. General information

NPI: 1750080941
Provider Name (Legal Business Name): JUSTIN ARAGON LADAC, LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-4965
US

IV. Provider business mailing address

6604 PAPAGAYO RD NW
ALBUQUERQUE NM
87120-7017
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-4140
  • Fax:
Mailing address:
  • Phone: 505-239-2832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2026-0327
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2023-0571
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: