Doctor Name: | JUDITH R. ANDREICA |
NPI Number: | 1265593495 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.ED. |
License Number: | LPCC1068 |
Business Practice Address: | 1220 Mount Taylor Ave Grants, NM - 870203149 |
Business Phone Number: | 5052877463 |
Business Fax Number: | 5052877463 |
Mailing Address: | 1220 Mount Taylor Ave, GRANTS |
State: | NM |
Postal Code: | 870203149 |
Phone Number: | 5052877463 |
Fax Number: | 5052877463 |
NPI Enumeration Date: | 12/12/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LPCC1068 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |