Individual
JENNIFER MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADAC
Contact information
Practice address
100 DEPUTY DEAN MIERA DR SW, ALBUQUERQUE, NM 87151-1000
(505) 365-7519
Mailing address
5901 ZUNI RD SE, ALBUQUERQUE, NM 87108-3073
(505) 365-7519
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CTB-2024-0658
NM
Other
Enumeration date
06/05/2026
Last updated
06/05/2026
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