Provider Demographics
NPI:1972836211
Name:MCDONALD, CONSTANCE MERRELL (LPCC, LPAT, LADAC)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:MERRELL
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LPCC, LPAT, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11930 MENAUL BLVD NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2478
Mailing Address - Country:US
Mailing Address - Phone:505-332-9242
Mailing Address - Fax:505-332-9140
Practice Address - Street 1:11930 MENAUL BLVD NE
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2478
Practice Address - Country:US
Practice Address - Phone:505-332-9242
Practice Address - Fax:505-332-9140
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0064411101YA0400X
NM006248101YM0800X
NM0065682101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)