Healthcare Provider Details

I. General information

NPI: 1710599394
Provider Name (Legal Business Name): KORINNA LEIGH DENNEHEY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 SILVER AVE SW STE 310
ALBUQUERQUE NM
87102-3184
US

IV. Provider business mailing address

625 SILVER AVE SW STE 310
ALBUQUERQUE NM
87102-3184
US

V. Phone/Fax

Practice location:
  • Phone: 505-436-3916
  • Fax:
Mailing address:
  • Phone: 505-436-3916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2022-0907
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: