Healthcare Provider Details

I. General information

NPI: 1306510276
Provider Name (Legal Business Name): LAURA DIANNE HIBBS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8214 2ND ST NW STE C
ALBUQUERQUE NM
87114-1091
US

IV. Provider business mailing address

PO BOX 15681
RIO RANCHO NM
87174-0681
US

V. Phone/Fax

Practice location:
  • Phone: 505-317-3792
  • Fax: 505-792-6611
Mailing address:
  • Phone: 505-317-3792
  • Fax: 505-926-6117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2024-0687
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: