Provider Demographics
NPI:1477515849
Name:CROSSLAND, VICKI R (LPCC, LADAC)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:R
Last Name:CROSSLAND
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:PO BOX 90
Mailing Address - Street 2:
Mailing Address - City:FAYWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:88034-0090
Mailing Address - Country:US
Mailing Address - Phone:505-536-9439
Mailing Address - Fax:505-536-9436
Practice Address - Street 1:301 W COLLEGE AVE
Practice Address - Street 2:SUITE 19
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5002
Practice Address - Country:US
Practice Address - Phone:505-388-4100
Practice Address - Fax:505-534-4000
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM006042101YA0400X
NM005496101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health