Healthcare Provider Details

I. General information

NPI: 1609878412
Provider Name (Legal Business Name): CARRIE L WILLEY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 169 MILE POST 29
MAGDALENA NM
87825
US

IV. Provider business mailing address

PO BOX 907
MAGDALENA NM
87825-0907
US

V. Phone/Fax

Practice location:
  • Phone: 505-854-2626
  • Fax: 505-854-2528
Mailing address:
  • Phone: 505-854-2628
  • Fax: 505-864-2528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0064471
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3047
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: