Healthcare Provider Details

I. General information

NPI: 1457543506
Provider Name (Legal Business Name): MARIE NICCOLE TORAL LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LENA ST BUILDING C-9
SANTA FE NM
87505-3891
US

IV. Provider business mailing address

125A MESA VISTA ST
SANTA FE NM
87501-1731
US

V. Phone/Fax

Practice location:
  • Phone: 505-629-9081
  • Fax:
Mailing address:
  • Phone: 505-629-9081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0119901
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9123
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: