Lisa Marie King, MA,LADAC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Canoncito, NM
NPI 1144535337 · NPPES record last updated Oct 26, 2015
Key facts
- NPI
- 1144535337
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 0131581 (NM)
- Practice address
- 86 Medicine Horse Dr.
86 Medicine Horse Dr.
Canoncito, NM 87026 - Phone
- (505) 908-2571
- NPI assigned
- Aug 11, 2010
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0131581 | NM | MD | Addiction (Substance Use Disorder) Counselor |
| 702824 | NM | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 702824 | NM | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 0131581 | NM | Yes |
Addresses
Primary practice location
86 Medicine Horse Dr.
86 Medicine Horse Dr.
Canoncito, NM 87026
Mailing address
86 Medicine Horse Dr.
86 Medicine Horse Dr.
Canoncito, NM 87026-3368
Phone (505) 908-2571
Other providers in Canoncito, NM
All providers in Canoncito, NM · Addiction (Substance Use Disorder) Counselor in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.