Healthcare Provider Details

I. General information

NPI: 1699470724
Provider Name (Legal Business Name): DARCIE LEE METRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 LOUISIANA BLVD NE STE 300
ALBUQUERQUE NM
87110-4394
US

IV. Provider business mailing address

10016 LOS ARBOLES AVE NE
ALBUQUERQUE NM
87112-1513
US

V. Phone/Fax

Practice location:
  • Phone: 505-302-1660
  • Fax:
Mailing address:
  • Phone: 505-697-9202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberCTB-2022-0309
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: