Healthcare Provider Details

I. General information

NPI: 1255896353
Provider Name (Legal Business Name): 32 DEGREES GENUINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 CARMEL AVE NE STE B
ALBUQUERQUE NM
87113-2843
US

IV. Provider business mailing address

5701 CARMEL AVE NE STE B
ALBUQUERQUE NM
87113-2843
US

V. Phone/Fax

Practice location:
  • Phone: 505-308-5226
  • Fax: 505-514-0754
Mailing address:
  • Phone: 505-595-6622
  • Fax: 505-514-0754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JESSICA R JOHNSON
Title or Position: THERAPIST/OWNER
Credential: LPCC
Phone: 505-595-6622