Provider Demographics
NPI:1801813738
Name:SLADE, VERONICA A (MA, LPCC)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:A
Last Name:SLADE
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 PHILLIPS DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-1658
Mailing Address - Country:US
Mailing Address - Phone:505-532-9598
Mailing Address - Fax:
Practice Address - Street 1:202 N MIRANDA ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2564
Practice Address - Country:US
Practice Address - Phone:575-202-2157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0118571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional