Healthcare Provider Details

I. General information

NPI: 1447439427
Provider Name (Legal Business Name): CONSCIOUSNESS COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13301 MANITOBA DR NE
ALBUQUERQUE NM
87111-2952
US

IV. Provider business mailing address

13301 MANITOBA DR NE
ALBUQUERQUE NM
87111-2952
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-9662
  • Fax:
Mailing address:
  • Phone: 505-265-9662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0894
License Number StateNM

VIII. Authorized Official

Name: MARY ROSE GHAMMACHI BENNETT
Title or Position: PROFESSIONAL COUNSELOR
Credential:
Phone: 505-265-9662