Healthcare Provider Details

I. General information

NPI: 1164808606
Provider Name (Legal Business Name): MARCIA RENEE FILIPIAK LPCC, LADAC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 ISTLE RD NE
RIO RANCHO NM
87124-1575
US

IV. Provider business mailing address

2600 ISTLE RD NE
RIO RANCHO NM
87124-1575
US

V. Phone/Fax

Practice location:
  • Phone: 505-289-0198
  • Fax: 505-592-5192
Mailing address:
  • Phone: 505-289-0198
  • Fax: 505-592-5192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0166121
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15840-131
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5141-125
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0173731
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: