Provider Demographics
NPI:1801017694
Name:MILNER, MARLENE (LADAC)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:MILNER
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PRAIRIE CREST DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-1315
Mailing Address - Country:US
Mailing Address - Phone:505-474-6368
Mailing Address - Fax:
Practice Address - Street 1:460 SAINT MICHAELS DR
Practice Address - Street 2:SUITE 806
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7619
Practice Address - Country:US
Practice Address - Phone:505-992-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0102061101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)