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General NPI Number Information
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NPI Number | 1649463209
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Entity Type | Individual
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Provider Name | KRISTINA MARIE VALDIVIEZO LPCC
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Gender | Female
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Dates
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Enumeration Date | 08/27/2007
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 1345 BRANSON AVE APT 8B
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City | LAS CRUCES
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State | NM
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Zip | 88001-0505
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Country | US
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Telephone | 575-937-9494
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Fax |
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Provider Business Mailing Address
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Address Line | 1345 BRANSON AVE APT 8B
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City | LAS CRUCES
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State | NM
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Zip | 88001-0505
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Country | US
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Telephone | 575-937-9494
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0136941
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License Number State | NM
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