Healthcare Provider Details

I. General information

NPI: 1952901647
Provider Name (Legal Business Name): DEBRA ANN CARTER LPCC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321B CANDELARIA RD NE STE 402
ALBUQUERQUE NM
87107-1908
US

IV. Provider business mailing address

621 MADEIRA DR SE
ALBUQUERQUE NM
87108-3613
US

V. Phone/Fax

Practice location:
  • Phone: 505-205-0763
  • Fax:
Mailing address:
  • Phone: 505-205-0763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MARI-ANNE CHANEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 505-554-3435