Healthcare Provider Details

I. General information

NPI: 1124262266
Provider Name (Legal Business Name): CAROL ANN CHAVEZ MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2908 INDIAN FARM LN NW
ALBUQUERQUE NM
87107-2640
US

IV. Provider business mailing address

PO BOX 7696
ALBUQUERQUE NM
87194-7696
US

V. Phone/Fax

Practice location:
  • Phone: 505-350-6764
  • Fax: 505-833-3108
Mailing address:
  • Phone: 505-350-6764
  • Fax: 505-833-3108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number99351
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: