Provider Demographics
NPI:1568727030
Name:LAJUENESSE, MARIE AURORA (CADAC, LADAC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:AURORA
Last Name:LAJUENESSE
Suffix:
Gender:F
Credentials:CADAC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 FIVE POINTS RD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-3179
Mailing Address - Country:US
Mailing Address - Phone:505-242-6919
Mailing Address - Fax:505-242-6929
Practice Address - Street 1:1528 FIVE POINTS RD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-3179
Practice Address - Country:US
Practice Address - Phone:505-242-6919
Practice Address - Fax:505-242-6929
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0134121101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)