Healthcare Provider Details

I. General information

NPI: 1952253429
Provider Name (Legal Business Name): DEBORAH JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 GIRARD BLVD NE
ALBUQUERQUE NM
87106-1823
US

IV. Provider business mailing address

PO BOX 65156
ALBUQUERQUE NM
87193-5156
US

V. Phone/Fax

Practice location:
  • Phone: 505-349-1795
  • Fax:
Mailing address:
  • Phone: 505-349-1795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: