Provider Demographics
NPI:1174982284
Name:DURRICH, KAITLIN ANNA (LPCC)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ANNA
Last Name:DURRICH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:KAITLIN
Other - Last Name:LENGERICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:1213 GEORGENE DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-6011
Mailing Address - Country:US
Mailing Address - Phone:575-770-5265
Mailing Address - Fax:
Practice Address - Street 1:1213 GEORGENE DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-6011
Practice Address - Country:US
Practice Address - Phone:575-770-5265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0201401101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional