Healthcare Provider Details

I. General information

NPI: 1518601962
Provider Name (Legal Business Name): SANTINA NICOLE SHIJE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 EAST RD STE 104
LOS ALAMOS NM
87544-4301
US

IV. Provider business mailing address

32 DEER TAIL RD
SANTA FE NM
87506-7272
US

V. Phone/Fax

Practice location:
  • Phone: 505-412-7756
  • Fax:
Mailing address:
  • Phone: 505-934-3201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberM-09543
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: