Healthcare Provider Details

I. General information

NPI: 1477859478
Provider Name (Legal Business Name): LAQUESIA LOVE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 UNSER BLVD NE
RIO RANCHO NM
87124-4045
US

IV. Provider business mailing address

184 UNSER BLVD NE STE 202
RIO RANCHO NM
87124-4045
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-0928
  • Fax: 505-443-8314
Mailing address:
  • Phone: 505-896-0928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2022-0878
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number63650
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: