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General NPI Number Information
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NPI Number | 1104040088
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Entity Type | Individual
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Provider Name | MICHAEL WAYNE GIDDINGS LADAC
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Gender | Male
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 12/07/2009
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Provider Practice Location Address
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Address Line | 1528 FIVE POINTS RD SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87105-3014
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Country | US
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Telephone | 505-242-6919
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Fax | 505-242-6929
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Provider Business Mailing Address
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Address Line | 606 CALLE DON DEMETRIO NE
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City | LOS LUNAS
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State | NM
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Zip | 87031-9360
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Country | US
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Telephone | 505-865-6748
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 005486
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License Number State | NM
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