Healthcare Provider Details

I. General information

NPI: 1851901243
Provider Name (Legal Business Name): DAVID A WEICHBRODT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9412 LAS CALABAZILLAS RD NE
ALBUQUERQUE NM
87111-2540
US

IV. Provider business mailing address

9412 LAS CALABAZILLAS RD NE
ALBUQUERQUE NM
87111-2540
US

V. Phone/Fax

Practice location:
  • Phone: 505-507-5796
  • Fax: 505-349-4842
Mailing address:
  • Phone: 505-507-5796
  • Fax: 505-349-4842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DAVID A WEICHBRODT
Title or Position: OWNER
Credential: LPCC
Phone: 505-507-5796