Healthcare Provider Details

I. General information

NPI: 1508428137
Provider Name (Legal Business Name): MICHAEL MCGEE LADAC, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S HUDSON ST STE 12
SILVER CITY NM
88061-6184
US

IV. Provider business mailing address

PO BOX 1349
SILVER CITY NM
88062-1349
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-4497
  • Fax: 575-597-4499
Mailing address:
  • Phone: 575-388-4497
  • Fax: 575-597-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAD0175321
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2022-1035
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: