Healthcare Provider Details

I. General information

NPI: 1801565445
Provider Name (Legal Business Name): LIDIA M VEGA CHAVIRA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 N GRANT ST STE A
SILVER CITY NM
88061-5134
US

IV. Provider business mailing address

1311 N GRANT ST STE A
SILVER CITY NM
88061-5134
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-1447
  • Fax: 575-388-1447
Mailing address:
  • Phone: 575-388-1447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2023-0325
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2025--1125
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: