Healthcare Provider Details

I. General information

NPI: 1134304868
Provider Name (Legal Business Name): LOIS M. DELONG PH.D, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10405 ANDRETTI AVE SW
ALBUQUERQUE NM
87121-8877
US

IV. Provider business mailing address

10405 ANDRETTI AVE SW
ALBUQUERQUE NM
87121-8877
US

V. Phone/Fax

Practice location:
  • Phone: 505-382-1470
  • Fax:
Mailing address:
  • Phone: 505-382-1470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0013102
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: