Provider Demographics
NPI:1295962439
Name:WAUNEKA, GREGORY (MA, LPCC, NCC)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:WAUNEKA
Suffix:
Gender:M
Credentials:MA, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 TRUMAN ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6443
Mailing Address - Country:US
Mailing Address - Phone:505-938-7131
Mailing Address - Fax:
Practice Address - Street 1:625 TRUMAN ST. NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3972
Practice Address - Country:US
Practice Address - Phone:505-938-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0111731101YM0800X
NM0150061101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health