Healthcare Provider Details

I. General information

NPI: 1497395883
Provider Name (Legal Business Name): ANGELA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 CARLISLE BLVD NE STE B
ALBUQUERQUE NM
87107-4566
US

IV. Provider business mailing address

4004 CARLISLE BLVD NE STE B
ALBUQUERQUE NM
87107-4566
US

V. Phone/Fax

Practice location:
  • Phone: 505-585-5024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2026-0073
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: