Provider Demographics
NPI:1912065723
Name:LUCERO, DONNA MARIE (LPCC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:LUCERO
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 1:2929 COORS BLVD NW STE 102B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1224
Mailing Address - Country:US
Mailing Address - Phone:505-314-7012
Mailing Address - Fax:505-839-7990
Practice Address - Street 1:2929 COORS BLVD NW STE 102B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1224
Practice Address - Country:US
Practice Address - Phone:505-314-7012
Practice Address - Fax:505-839-7990
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM005796101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional