Provider Demographics
NPI:1841517117
Name:LAYNE, DEVON NICHOLE (LMSW)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:NICHOLE
Last Name:LAYNE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 GOLD AVE SW APT A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2872
Mailing Address - Country:US
Mailing Address - Phone:505-710-8781
Mailing Address - Fax:
Practice Address - Street 1:1216 GOLD AVE SW APT A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2872
Practice Address - Country:US
Practice Address - Phone:505-710-8781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-07213251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health