Healthcare Provider Details

I. General information

NPI: 1548116437
Provider Name (Legal Business Name): DIRT LOT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 CARLISLE BLVD NE APT J6
ALBUQUERQUE NM
87109-1060
US

IV. Provider business mailing address

4601 CARLISLE BLVD NE APT J6
ALBUQUERQUE NM
87109-1060
US

V. Phone/Fax

Practice location:
  • Phone: 505-916-2040
  • Fax:
Mailing address:
  • Phone: 505-916-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: ASTRIA ALEXANDRIA RAYMOS
Title or Position: OWNER
Credential: LSAA
Phone: 505-916-2040