Healthcare Provider Details

I. General information

NPI: 1619077492
Provider Name (Legal Business Name): GEOFFREY SLAVIN M. A., LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2128 SILVER AVE SE
ALBUQUERQUE NM
87106-4010
US

IV. Provider business mailing address

2128 SILVER AVE SE
ALBUQUERQUE NM
87106-4010
US

V. Phone/Fax

Practice location:
  • Phone: 505-263-4476
  • Fax: 505-262-1695
Mailing address:
  • Phone: 505-263-4476
  • Fax: 505-262-1695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0587
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: