Healthcare Provider Details

I. General information

NPI: 1184776932
Provider Name (Legal Business Name): MARY C CARDER LMFT LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S HUDSON SUITE 19
SILVER CITY NM
88061
US

IV. Provider business mailing address

PO BOX 1349
SILVER CITY NM
88062-1349
US

V. Phone/Fax

Practice location:
  • Phone: 505-388-4497
  • Fax: 505-534-1150
Mailing address:
  • Phone: 505-388-4497
  • Fax: 505-534-1150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0074111
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0074041
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: