Healthcare Provider Details

I. General information

NPI: 1124893383
Provider Name (Legal Business Name): STEPHANIE SMITH COUNSELING AND CONSULTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 MESA GRANDE PL SE
ALBUQUERQUE NM
87108-2709
US

IV. Provider business mailing address

4210 MESA GRANDE PL SE
ALBUQUERQUE NM
87108-2709
US

V. Phone/Fax

Practice location:
  • Phone: 520-288-1079
  • Fax:
Mailing address:
  • Phone: 520-288-1079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE SMITH
Title or Position: OWNER
Credential: LPCC
Phone: 520-288-1079