Healthcare Provider Details

I. General information

NPI: 1316399074
Provider Name (Legal Business Name): CAROLINA ORTEGA MA, LPCC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 INDIAN SCHOOL RD NE STE 200
ALBUQUERQUE NM
87110-4082
US

IV. Provider business mailing address

7109 DONA ESMERA AVE SW
ALBUQUERQUE NM
87121-3591
US

V. Phone/Fax

Practice location:
  • Phone: 505-657-4161
  • Fax: 505-531-8020
Mailing address:
  • Phone: 505-489-0854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0207961
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: