Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 0141441 | NM |
Y | 101YM0800X | Mental Health Counselor | T-0175781 | NM |
NPI | 1003297235 |
---|---|
Provider Name | Kristin Birkenes |
First Address | Albuquerque, NM 87111-6814 |
Second Address | Albuquerque, NM 87111-6814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2015 |
Last Update Date | 31/08/2015 |