Healthcare Provider Details

I. General information

NPI: 1649376989
Provider Name (Legal Business Name): ELEANORE S DOUGLAS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEA S DOUGLAS LPCC

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 FLORA DR
SANTA FE NM
87505-5221
US

IV. Provider business mailing address

1011 FLORA DR
SANTA FE NM
87505-5221
US

V. Phone/Fax

Practice location:
  • Phone: 505-310-5988
  • Fax:
Mailing address:
  • Phone: 505-310-5988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0091581
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0091581
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0091581
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0091581
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: