Provider Demographics
NPI:1508965021
Name:STUCKY-ABBOTT, LEONA K (DMIN)
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:K
Last Name:STUCKY-ABBOTT
Suffix:
Gender:F
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MESA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1732
Mailing Address - Country:US
Mailing Address - Phone:505-820-2433
Mailing Address - Fax:505-984-9974
Practice Address - Street 1:140 MESA VISTA ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1732
Practice Address - Country:US
Practice Address - Phone:505-820-2433
Practice Address - Fax:505-984-9974
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3020101YM0800X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral