Healthcare Provider Details

I. General information

NPI: 1396189619
Provider Name (Legal Business Name): BARBARA WHIPPLE LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 ROTTEN TREE ROAD
TAOS NM
87571
US

IV. Provider business mailing address

PO BOX 1846
TAOS NM
87571-1846
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-7824
  • Fax: 575-758-3346
Mailing address:
  • Phone: 575-758-7824
  • Fax: 575-758-3346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number005427
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: