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General NPI Number Information
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NPI Number | 1376735464
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Entity Type | Individual
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Provider Name | JOSEPH E. SWEENEY LPC/LADAC/SAP
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Gender | Male
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 09/29/2011
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Provider Practice Location Address
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Address Line | 103A SAGAR DRIVE
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City | VANDERWAGEN
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State | NM
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Zip | 87326
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Country | US
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Telephone | 505-778-5151
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Fax | 505-772-5151
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | VANDERWAGEN
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State | NM
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Zip | 87326-0190
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Country | US
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Telephone | 505-778-5151
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Fax | 505-778-5151
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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 | T-0104081
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0089971
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License Number State | NM
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