Provider Demographics
NPI:1861742926
Name:VIGIL, MARYAH JEAN (LPCC; CRC)
Entity type:Individual
Prefix:MISS
First Name:MARYAH
Middle Name:JEAN
Last Name:VIGIL
Suffix:
Gender:F
Credentials:LPCC; CRC
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Mailing Address - Street 1:218 BROADWAY BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3425
Mailing Address - Country:US
Mailing Address - Phone:505-242-6988
Mailing Address - Fax:505-242-6972
Practice Address - Street 1:218 BROADWAY BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3425
Practice Address - Country:US
Practice Address - Phone:505-242-6988
Practice Address - Fax:505-242-6972
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM0175211101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional