Healthcare Provider Details

I. General information

NPI: 1972090629
Provider Name (Legal Business Name): NONA A COLLINS LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NONA A COLLINS LSAA,CCSS

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 GOLD AVE SW STE 102
ALBUQUERQUE NM
87102-3187
US

IV. Provider business mailing address

2444 PLAZA VIZCAYA NW
ALBUQUERQUE NM
87104-2936
US

V. Phone/Fax

Practice location:
  • Phone: 505-318-5750
  • Fax:
Mailing address:
  • Phone: 505-318-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAD0224801
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: