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General NPI Number Information
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NPI Number | 1831757608
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Entity Type | Individual
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Provider Name | LONI CARLISLE LMSW
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Gender | Female
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Dates
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Enumeration Date | 06/05/2019
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 906 VIRGINIA AVE STE B
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City | ALAMOGORDO
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State | NM
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Zip | 88310-6763
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Country | US
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Telephone | 575-415-4950
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Fax |
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Provider Business Mailing Address
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Address Line | 27777 INKSTER RD STE 100
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-5326
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | SWB-2024-1071
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License Number State | NM
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