Healthcare Provider Details

I. General information

NPI: 1780928531
Provider Name (Legal Business Name): KRISTINA M MARCH LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2012
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6596 SAHCHU LN
COCHITI LAKE NM
87083-6013
US

IV. Provider business mailing address

6596 SAHCHU LN
COCHITI LAKE NM
87083-6013
US

V. Phone/Fax

Practice location:
  • Phone: 505-366-1842
  • Fax:
Mailing address:
  • Phone: 505-366-1842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0175271
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: