Individual
MS. DEMETRA CHILDRESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
4425 JUAN TABO BLVD NE, SUITE 103, ALBUQUERQUE, NM 87111-2681
(505) 292-8908
(505) 292-3109
Mailing address
4425 JUAN TABO BLVD NE, SUITE 103, ALBUQUERQUE, NM 87111-2681
(505) 292-8908
(505) 292-3109
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0975
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01357573
—
NM
01
—
201012073
PRESBYTERIAN HEALTH PLAN
NM
01
—
NM101536
VALUE OPTIONS SALVD
NM
Enumeration date
12/18/2006
Last updated
06/15/2014
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