Provider Demographics
NPI:1730417627
Name:HETTIGER, SHERRY LOU (LPCC, LADAC)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LOU
Last Name:HETTIGER
Suffix:
Gender:F
Credentials:LPCC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N WHITE SANDS BLVD STE 112A
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6774
Mailing Address - Country:US
Mailing Address - Phone:575-491-3710
Mailing Address - Fax:575-415-3764
Practice Address - Street 1:1200 N WHITE SANDS BLVD STE 112A
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6774
Practice Address - Country:US
Practice Address - Phone:575-491-3710
Practice Address - Fax:575-415-3764
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0145441101YM0800X
NM01177751101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)