Provider Demographics
NPI:1265653133
Name:DECKER, SHARLENE (LADAC)
Entity type:Individual
Prefix:
First Name:SHARLENE
Middle Name:
Last Name:DECKER
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 1:9900 SPAIN RD NE
Mailing Address - Street 2:APT G2036
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1988
Mailing Address - Country:US
Mailing Address - Phone:505-352-4019
Mailing Address - Fax:
Practice Address - Street 1:2625 PENNSYLVANIA ST NE
Practice Address - Street 2:SUITE 500
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3615
Practice Address - Country:US
Practice Address - Phone:505-232-9115
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
NM0102951101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)