Healthcare Provider Details

I. General information

NPI: 1528168606
Provider Name (Legal Business Name): ALIVIAR COUNSELING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 YALE BLVD SE SUITE C-6
ALBUQUERQUE NM
87106-4228
US

IV. Provider business mailing address

2301 YALE BLVD SE SUITE C-6
ALBUQUERQUE NM
87106-4228
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-4622
  • Fax: 505-247-1373
Mailing address:
  • Phone: 505-247-4622
  • Fax: 505-247-1373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3676
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3678
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-0094391
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0065322
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0088171
License Number StateNM
# 6
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-07173
License Number StateNM

VIII. Authorized Official

Name: CARL REGENSBERG
Title or Position: CEO
Credential: LADAC
Phone: 505-247-4622