Individual
WHITNEY LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
208 PASEO DEL PUEBLO SUR UNIT 103, TAOS, NM 87571-5931
(575) 770-7836
Mailing address
PO BOX 164, ARROYO SECO, NM 87514-0164
(575) 770-7836
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-11813
NM
Other
Enumeration date
05/31/2023
Last updated
05/31/2023
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