Individual
DIANA DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
4730 BECKNER RD, SANTA FE, NM 87507-3691
(505) 989-4500
(505) 443-8313
Mailing address
4730 BECKNER RD, SANTA FE, NM 87507-3691
(505) 989-4500
(505) 443-8313
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
CTB-2025-0123
NM
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
05/10/2016
Last updated
05/19/2025
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