Healthcare Provider Details

I. General information

NPI: 1770658247
Provider Name (Legal Business Name): NANCY A JOHNSON LPCC LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 OSUNA RD NE STE A2 BLDG. A-2
ALBUQUERQUE NM
87107-5953
US

IV. Provider business mailing address

320 OSUNA RD NE STE A2 BLDG. A-2
ALBUQUERQUE NM
87107-5953
US

V. Phone/Fax

Practice location:
  • Phone: 505-346-0824
  • Fax: 505-341-2287
Mailing address:
  • Phone: 505-346-0824
  • Fax: 505-341-2287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number02-103316-00-1
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: