Provider Demographics
NPI:1326493370
Name:THEODORE-SPALDING, ALEX JOHN (LPCC)
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:JOHN
Last Name:THEODORE-SPALDING
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 OLD PECOS TRL STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4779
Mailing Address - Country:US
Mailing Address - Phone:505-657-9708
Mailing Address - Fax:
Practice Address - Street 1:1660 OLD PECOS TRL STE A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4779
Practice Address - Country:US
Practice Address - Phone:505-657-9708
Practice Address - Fax:505-395-9295
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0217571101YP2500X
101YM0800X
CO0013008101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health