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General NPI Number Information
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NPI Number | 1942113048
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Entity Type | Individual
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Provider Name | EMILIE SARA VON HARDERS LSAA
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Gender | Female
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 2300 YALE BLVD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4273
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Country | US
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Telephone | 505-312-6175
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Fax |
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Provider Business Mailing Address
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Address Line | 317 15TH ST NW UNIT 3
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City | ALBUQUERQUE
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State | NM
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Zip | 87104-1256
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Country | US
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Telephone | 505-695-8853
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CTB-2026-0447
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License Number State | NM
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