Provider Demographics
NPI:1457543506
Name:TORAL, MARIE NICCOLE (LPCC)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:NICCOLE
Last Name:TORAL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125A MESA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1731
Mailing Address - Country:US
Mailing Address - Phone:505-629-9081
Mailing Address - Fax:
Practice Address - Street 1:1600 LENA ST
Practice Address - Street 2:BUILDING C-9
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3891
Practice Address - Country:US
Practice Address - Phone:505-629-9081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0119901101YP2500X
NC9123101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM57322261Medicaid