Healthcare Provider Details

I. General information

NPI: 1174982284
Provider Name (Legal Business Name): KAITLIN ANNA DURRICH LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA KAITLIN LENGERICH LPCC

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 GEORGENE DR NE
ALBUQUERQUE NM
87112-6011
US

IV. Provider business mailing address

1213 GEORGENE DR NE
ALBUQUERQUE NM
87112-6011
US

V. Phone/Fax

Practice location:
  • Phone: 575-770-5265
  • Fax:
Mailing address:
  • Phone: 575-770-5265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0201401
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: