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General NPI Number Information
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NPI Number | 1881477735
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Entity Type | Individual
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Provider Name | AMANDA ANN JAMES LSAA
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Gender | Female
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Dates
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Enumeration Date | 08/15/2023
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 625 TRUMAN ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-6443
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Country | US
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Telephone | 505-262-6527
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Fax | 505-265-7045
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Provider Business Mailing Address
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Address Line | 5608 ZUNI RD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-2926
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Country | US
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Telephone | 505-262-6527
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Fax | 505-265-7045
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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 | CTB-2023-0682
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License Number State | NM
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