Healthcare Provider Details

I. General information

NPI: 1972780849
Provider Name (Legal Business Name): SANDRA J. GARRIOTT-STEJSKAL MA, LPCC, LPAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A.H.C.H. 1217 1ST ST NW
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

1217 1ST ST NW ALBUQUERQUE HEALTH CARE FOR THE HOMELESS
ALBUQUERQUE NM
87102
US

V. Phone/Fax

Practice location:
  • Phone: 505-831-7815
  • Fax: 505-831-7816
Mailing address:
  • Phone: 505-831-7815
  • Fax: 505-831-7816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2491 AND 2484
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: