Provider Demographics
NPI:1043322498
Name:GINGA, MARIE (LPCC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:GINGA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 ASHLEY LN
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-8922
Mailing Address - Country:US
Mailing Address - Phone:505-450-1948
Mailing Address - Fax:505-898-8900
Practice Address - Street 1:4448 CORRLAES RD.
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048
Practice Address - Country:US
Practice Address - Phone:505-450-1948
Practice Address - Fax:505-898-8900
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0083821101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health