Provider Demographics
NPI:1184955841
Name:RADTKE, ADRIENNE PAIGE (LMHC)
Entity type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:PAIGE
Last Name:RADTKE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 TRAMWAY PL NE APT B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-1620
Mailing Address - Country:US
Mailing Address - Phone:505-363-9476
Mailing Address - Fax:
Practice Address - Street 1:1218 GRIEGOS RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-3752
Practice Address - Country:US
Practice Address - Phone:505-342-5939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0120401101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)