Provider Demographics
NPI:1295018836
Name:HERNDON, DEVON DEYARMAN (LPCC)
Entity Type:Individual
Prefix:MS
First Name:DEVON
Middle Name:DEYARMAN
Last Name:HERNDON
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 1:67 MADOLE RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-9503
Mailing Address - Country:US
Mailing Address - Phone:505-469-0779
Mailing Address - Fax:888-506-2110
Practice Address - Street 1:3736 EUBANK BLVD NE
Practice Address - Street 2:SUITE B-1
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3579
Practice Address - Country:US
Practice Address - Phone:505-280-5860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0168461101YP2500X
NM0163911101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18359302Medicaid