Healthcare Provider Details

I. General information

NPI: 1619676731
Provider Name (Legal Business Name): CHAREST COUNSELING AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8205 SPAIN RD NE STE 209C
ALBUQUERQUE NM
87109-3130
US

IV. Provider business mailing address

8205 SPAIN RD NE STE 209C
ALBUQUERQUE NM
87109-3130
US

V. Phone/Fax

Practice location:
  • Phone: 505-675-4422
  • Fax:
Mailing address:
  • Phone: 505-675-4422
  • Fax:

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: KATHLEEN CHAREST
Title or Position: OWNER
Credential: LPCC
Phone: 505-675-4422