Individual
MS. DIANA LIGHTMOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPCC, LMT
Contact information
Practice address
5 CALIENTE RD STE 2C, SANTA FE, NM 87508-9205
(505) 577-4607
(505) 466-1277
Mailing address
29 CHAPALA RD, SANTA FE, NM 87508-2206
(505) 577-4607
(505) 466-1277
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0228
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
67985041
—
NM
Enumeration date
04/18/2008
Last updated
06/30/2015
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