Provider Demographics
NPI:1538978978
Name:ANAYA, SANORA J (LSAA)
Entity type:Individual
Prefix:
First Name:SANORA
Middle Name:J
Last Name:ANAYA
Suffix:
Gender:F
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 LEWIS AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-4346
Mailing Address - Country:US
Mailing Address - Phone:928-296-1360
Mailing Address - Fax:
Practice Address - Street 1:11500 MENAUL BLVD NE STE L
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2442
Practice Address - Country:US
Practice Address - Phone:505-526-3649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0733101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)