Provider Demographics
NPI:1811229164
Name:FRANCO, EDELMIRA (LPC, LADAC)
Entity Type:Individual
Prefix:
First Name:EDELMIRA
Middle Name:
Last Name:FRANCO
Suffix:
Gender:F
Credentials:LPC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 SUNSHINE WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-9166
Mailing Address - Country:US
Mailing Address - Phone:505-471-3381
Mailing Address - Fax:
Practice Address - Street 1:2074 GALISTEO ST STE B4
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2157
Practice Address - Country:US
Practice Address - Phone:505-501-3683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0087121101YA0400X
NM2094101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)