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General NPI Number Information
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NPI Number | 1972836211
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Entity Type | Individual
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Provider Name | CONSTANCE MERRELL MCDONALD LPCC, LPAT, LADAC
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Gender | Female
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Dates
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Enumeration Date | 09/17/2009
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Last Update Date | 09/17/2009
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Provider Practice Location Address
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Address Line | 11930 MENAUL BLVD NE SUITE 101
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-2478
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Country | US
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Telephone | 505-332-9242
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Fax | 505-332-9140
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Provider Business Mailing Address
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Address Line | 11930 MENAUL BLVD NE SUITE 101
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-2478
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Country | US
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Telephone | 505-332-9242
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Fax | 505-332-9140
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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 | 0064411
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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 | 006248
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0065682
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License Number State | NM
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