Provider Demographics
NPI:1225019250
Name:WEE, NAN DENICE (LPCC LADAC)
Entity Type:Individual
Prefix:MS
First Name:NAN
Middle Name:DENICE
Last Name:WEE
Suffix:
Gender:F
Credentials:LPCC LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10512 GUADALAJARA AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1719
Mailing Address - Country:US
Mailing Address - Phone:505-373-9065
Mailing Address - Fax:
Practice Address - Street 1:10512 GUADALAJARA AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1719
Practice Address - Country:US
Practice Address - Phone:505-373-9065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0124081101YA0400X
NM0111751101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM59572833Medicaid