Provider Demographics
NPI:1609878412
Name:WILLEY, CARRIE L (LPCC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:WILLEY
Suffix:
Gender:F
Credentials:LPCC
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 907
Mailing Address - Street 2:
Mailing Address - City:MAGDALENA
Mailing Address - State:NM
Mailing Address - Zip Code:87825-0907
Mailing Address - Country:US
Mailing Address - Phone:505-854-2628
Mailing Address - Fax:505-864-2528
Practice Address - Street 1:HWY 169 MILE POST 29
Practice Address - Street 2:
Practice Address - City:MAGDALENA
Practice Address - State:NM
Practice Address - Zip Code:87825
Practice Address - Country:US
Practice Address - Phone:505-854-2626
Practice Address - Fax:505-854-2528
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0064471101YA0400X
NM3047101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional