Provider Demographics
NPI:1396846663
Name:DUBUQUE, TERESA A (MA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:DUBUQUE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7421 GILA RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3807
Mailing Address - Country:US
Mailing Address - Phone:505-822-1623
Mailing Address - Fax:505-856-7103
Practice Address - Street 1:8600 ACADEMY RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1107
Practice Address - Country:US
Practice Address - Phone:505-821-3628
Practice Address - Fax:505-856-7103
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2224101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health