Healthcare Provider Details

I. General information

NPI: 1376304014
Provider Name (Legal Business Name): MCCALL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4477 IRVING BLVD NW STE B
ALBUQUERQUE NM
87114-5529
US

IV. Provider business mailing address

6720 BOCA NEGRA PL NW
ALBUQUERQUE NM
87120-1327
US

V. Phone/Fax

Practice location:
  • Phone: 505-550-9366
  • Fax:
Mailing address:
  • Phone: 505-550-9366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARLINA C MCCALL
Title or Position: CLINICAL DIRECTOR
Credential: LPCC
Phone: 505-550-9366