Healthcare Provider Details

I. General information

NPI: 1982279030
Provider Name (Legal Business Name): LISA JOHNSON-CALDWELL LSAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N MAIN ST STE 1
LAS CRUCES NM
88001-1281
US

IV. Provider business mailing address

414 N MAIN ST STE 1
LAS CRUCES NM
88001-1281
US

V. Phone/Fax

Practice location:
  • Phone: 575-600-6575
  • Fax:
Mailing address:
  • Phone: 575-600-6575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2024-0149
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: