Healthcare Provider Details

I. General information

NPI: 1063539583
Provider Name (Legal Business Name): DENNIS ABERNATHY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CARLISLE BLVD NE STE 225
ALBUQUERQUE NM
87110-1664
US

IV. Provider business mailing address

8528 PALOMAR AVE NE
ALBUQUERQUE NM
87109-7200
US

V. Phone/Fax

Practice location:
  • Phone: 505-249-7779
  • Fax:
Mailing address:
  • Phone: 505-856-0191
  • Fax: 505-858-2424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1396
License Number StateNM

VIII. Authorized Official

Name: MR. DENNIS BROOKS ABERNATHY
Title or Position: DIRECTOR
Credential:
Phone: 505-249-7779