Healthcare Provider Details

I. General information

NPI: 1265651004
Provider Name (Legal Business Name): DIANE HELEN WILHOITE MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 HIGHWAY 313
BERNALILLO NM
87004-6912
US

IV. Provider business mailing address

4200 DARA DR NE
RIO RANCHO NM
87144-8458
US

V. Phone/Fax

Practice location:
  • Phone: 505-771-5384
  • Fax:
Mailing address:
  • Phone: 505-771-8901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2763
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: