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General NPI Number Information
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NPI Number | 1053819516
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Entity Type | Individual
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Provider Name | MARY LINDA JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 01/30/2018
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Last Update Date | 01/30/2018
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Provider Practice Location Address
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Address Line | 1330 SAN PEDRO DR NE STE 201B
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-6749
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Country | US
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Telephone | 575-707-8150
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Fax | 505-212-1446
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Provider Business Mailing Address
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Address Line | 2617 CHARLESTON ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-3605
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Country | US
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Telephone | 575-707-8150
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Fax | 505-212-1446
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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