Angelica Deidre Medina, CCSW
Individual provider Active NPI Counselor · Questa, NM
NPI 1295020022 · NPPES record last updated Mar 6, 2017
Key facts
- NPI
- 1295020022
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 2573 State Highway 522
Questa, NM 87556 - Phone
- (575) 586-0315
- NPI assigned
- Jun 9, 2011
- 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
2573 State Highway 522
Questa, NM 87556
Mailing address
PO Box 2267
Santa Fe, NM 87504-2267
Phone (505) 296-8292
Other providers in Questa, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2017. 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.