Provider Demographics
NPI:1518601962
Name:SHIJE, SANTINA NICOLE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SANTINA
Middle Name:NICOLE
Last Name:SHIJE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 DEER TAIL RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-7272
Mailing Address - Country:US
Mailing Address - Phone:505-934-3201
Mailing Address - Fax:
Practice Address - Street 1:195 EAST RD STE 104
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-4301
Practice Address - Country:US
Practice Address - Phone:505-412-7756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-09543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health