Healthcare Provider Details

I. General information

NPI: 1407189301
Provider Name (Legal Business Name): REBECCA L LEDEZMA-CHINCHILLA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4619 GREEN ST NW SUITE D
ALBUQUERQUE NM
87114
US

IV. Provider business mailing address

4619 GREENE ST NW STE D
ALBUQUERQUE NM
87114-4899
US

V. Phone/Fax

Practice location:
  • Phone: 505-417-3824
  • Fax:
Mailing address:
  • Phone: 505-417-3824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: