Healthcare Provider Details

I. General information

NPI: 1295018836
Provider Name (Legal Business Name): DEVON DEYARMAN HERNDON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3736 EUBANK BLVD NE SUITE B-1
ALBUQUERQUE NM
87111-3579
US

IV. Provider business mailing address

67 MADOLE RD
EDGEWOOD NM
87015-9503
US

V. Phone/Fax

Practice location:
  • Phone: 505-280-5860
  • Fax:
Mailing address:
  • Phone: 505-469-0779
  • Fax: 888-506-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0168461
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0163911
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: