Healthcare Provider Details

I. General information

NPI: 1033350681
Provider Name (Legal Business Name): SARAH MARIE HARDING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4359 JAGER DR NE
RIO RANCHO NM
87144-0916
US

IV. Provider business mailing address

4359 JAQUER DR. NE
RIO RANCHO NM
87144
US

V. Phone/Fax

Practice location:
  • Phone: 505-867-3866
  • Fax:
Mailing address:
  • Phone: 505-867-3866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT - 0120161
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: