Healthcare Provider Details

I. General information

NPI: 1780745257
Provider Name (Legal Business Name): CHARLOTTE KNAUBER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 ACADEMY RD NE BLDG. 1 SUITE 202
ALBUQUERQUE NM
87109-3379
US

IV. Provider business mailing address

7801 ACADEMY RD NE BLDG. 1 SUITE 202
ALBUQUERQUE NM
87109-3379
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-9391
  • Fax: 505-265-7860
Mailing address:
  • Phone: 505-262-9391
  • Fax: 505-265-7860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1423
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: