Healthcare Provider Details

I. General information

NPI: 1669157079
Provider Name (Legal Business Name): THA SWEET LIFE 2 DPR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 GOLD AVE SW # 702
ALBUQUERQUE NM
87102-3283
US

IV. Provider business mailing address

400 GOLD AVE SW # 702
ALBUQUERQUE NM
87102-3283
US

V. Phone/Fax

Practice location:
  • Phone: 806-443-0816
  • Fax:
Mailing address:
  • Phone: 806-443-0816
  • 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: MISS KAWANNA MORRIS
Title or Position: FOUNDER/ EXCECUTIVE DIRECTOR
Credential: CPSW, CCSS, CADAC
Phone: 806-443-0816