Individual
MS. LISA MARDEL SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1122 CENTRAL AVE SW, ALBUQUERQUE, NM 87102-2947
(505) 639-5916
Mailing address
301 SAN ANDRES AVE NW, ALBUQUERQUE, NM 87107-3950
(505) 639-5916
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CTB-2023-0939
NM
225700000X
Massage Therapist
17178
OR
Other
Enumeration date
02/15/2011
Last updated
11/13/2023
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