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General NPI Number Information
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NPI Number | 1205169596
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Entity Type | Individual
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Provider Name | SHERRIJEAN M SERNA LADAC
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Gender | Female
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Dates
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Enumeration Date | 09/17/2009
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 1114 PLAZA DEL NORTE STE B
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City | ESPANOLA
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State | NM
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Zip | 87532-3216
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Country | US
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Telephone | 505-753-8933
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Fax | 505-753-9811
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Provider Business Mailing Address
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Address Line | 1114 PLAZA DEL NORTE SUITE B
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City | ESPANOLA
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State | NM
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Zip | 87532-3216
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Country | US
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Telephone | 505-753-8933
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Fax | 505-753-9811
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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 | 0087651
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License Number State | NM
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