Provider Demographics
NPI:1053048264
Name:SUAZO, ADRIANNA B (LMHC)
Entity type:Individual
Prefix:
First Name:ADRIANNA
Middle Name:B
Last Name:SUAZO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:NM
Mailing Address - Zip Code:87527-0535
Mailing Address - Country:US
Mailing Address - Phone:505-927-4562
Mailing Address - Fax:
Practice Address - Street 1:835 SPRUCE ST STE C&D
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3455
Practice Address - Country:US
Practice Address - Phone:505-747-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-07
Last Update Date:2023-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NMCTB-2023-0059101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health