Provider Demographics
NPI:1518074749
Name:ABERCROMBIE, BRENDA RAE (MA, LPCC, LADAC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:RAE
Last Name:ABERCROMBIE
Suffix:
Gender:F
Credentials:MA, LPCC, LADAC
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:RAE
Other - Last Name:ATWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88311-0306
Mailing Address - Country:US
Mailing Address - Phone:575-585-4319
Mailing Address - Fax:575-993-5303
Practice Address - Street 1:900 ST FRANCIS DR
Practice Address - Street 2:
Practice Address - City:TULAROSA
Practice Address - State:NM
Practice Address - Zip Code:88352-2328
Practice Address - Country:US
Practice Address - Phone:575-585-4319
Practice Address - Fax:575-993-5303
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1271 (LPCC)101YM0800X
NM006083 (LADAC)101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM01JA60OtherBCBS OF NM
NMNM101063OtherVALUEOPTIONS
NM24078OtherLOVELACE HEALTH PLAN
NM97235211Medicaid
NM201023019OtherPRESBYTERIAN HEALTH PLAN