Healthcare Provider Details

I. General information

NPI: 1437832532
Provider Name (Legal Business Name): CGC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 GOLD AVE SW STE 102
ALBUQUERQUE NM
87102-3187
US

IV. Provider business mailing address

610 GOLD AVE SW STE 102
ALBUQUERQUE NM
87102-3187
US

V. Phone/Fax

Practice location:
  • Phone: 505-318-5750
  • Fax:
Mailing address:
  • Phone: 505-318-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NONA A COLLINS
Title or Position: OWNER
Credential: LADAC
Phone: 505-318-5750