Healthcare Provider Details

I. General information

NPI: 1427467547
Provider Name (Legal Business Name): ALBUQUERQUE GUIDANCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 LOVEJOY RD SW
ALBUQUERQUE NM
87105-3849
US

IV. Provider business mailing address

2741 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87106-2653
US

V. Phone/Fax

Practice location:
  • Phone: 505-750-8866
  • Fax: 707-444-8368
Mailing address:
  • Phone: 505-750-8866
  • Fax: 505-444-8368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberFA0098824
License Number StateNM

VIII. Authorized Official

Name: CHARMAINE D LOPEZ
Title or Position: CEO/CLINICAL DIRECTOR
Credential: LPCC
Phone: 505-750-8866