Healthcare Provider Details

I. General information

NPI: 1891731469
Provider Name (Legal Business Name): RHONDA ETHEL NESWALD PH.D., LPCC, ACS, NC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CENTRAL AVE SW 2500W EXECUTIVE SUITE D
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

1101 MARQUETTE AVE NW
ALBUQUERQUE NM
87102-1861
US

V. Phone/Fax

Practice location:
  • Phone: 505-225-7466
  • Fax:
Mailing address:
  • Phone: 505-350-5695
  • Fax: 505-275-0296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0069871
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0069871
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: