Healthcare Provider Details

I. General information

NPI: 1164662029
Provider Name (Legal Business Name): DIANE LYNN SANCHEZ MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 CARLISLE NE
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

1121 MAXINE ST NE
ALBUQUERQUE NM
87112-5622
US

V. Phone/Fax

Practice location:
  • Phone: 505-818-0753
  • Fax:
Mailing address:
  • Phone: 505-818-0753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberT-0118181
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: