Healthcare Provider Details

I. General information

NPI: 1942334776
Provider Name (Legal Business Name): CHRISTINA FORDE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 09/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-5660
US

IV. Provider business mailing address

PO BOX 53002
ALBUQUERQUE NM
87153-3002
US

V. Phone/Fax

Practice location:
  • Phone: 505-401-1802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0095291
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: