Provider Demographics
NPI:1437341286
Name:WOLFSPIRT, NIAONNA WATERS (LISW)
Entity Type:Individual
Prefix:
First Name:NIAONNA
Middle Name:WATERS
Last Name:WOLFSPIRT
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 W 6TH ST APT 11
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-3760
Mailing Address - Country:US
Mailing Address - Phone:505-982-8870
Mailing Address - Fax:505-982-0620
Practice Address - Street 1:1441 S. SOUTH ST. FRANCIS DR.
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-982-2271
Practice Address - Fax:505-982-0620
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-05602101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health