Healthcare Provider Details

I. General information

NPI: 1164146981
Provider Name (Legal Business Name): ELISA M WOODS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 GOLD AVE SW STE 1300
ALBUQUERQUE NM
87102-3274
US

IV. Provider business mailing address

3645 MOSSWOOD AVE
ALAMOGORDO NM
88310-8271
US

V. Phone/Fax

Practice location:
  • Phone: 505-715-4610
  • Fax:
Mailing address:
  • Phone: 575-551-4061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2025-0214
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: