Healthcare Provider Details

I. General information

NPI: 1467609461
Provider Name (Legal Business Name): BARBARA ANN THOMPSON LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 ANTHONY DR SUITE 1
ANTHONY NM
88021-9346
US

IV. Provider business mailing address

PO BOX 1988
ANTHONY NM
88021-1988
US

V. Phone/Fax

Practice location:
  • Phone: 575-635-2182
  • Fax:
Mailing address:
  • Phone: 575-635-2182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0112631
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: