Provider Demographics
NPI:1639364557
Name:CLINE, STUART H (LPCC, LADAC, LPAT)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:H
Last Name:CLINE
Suffix:
Gender:M
Credentials:LPCC, LADAC, LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 CARLISLE BLVD NE, STE 210
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4849
Mailing Address - Country:US
Mailing Address - Phone:505-247-1921
Mailing Address - Fax:505-247-1020
Practice Address - Street 1:4308 CARLISLE BLVD NE, STE 210
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4849
Practice Address - Country:US
Practice Address - Phone:505-247-1921
Practice Address - Fax:505-247-1020
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM89221101YA0400X
NM5523101YP2500X
NMCCMH0109631101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM07257279Medicaid