Healthcare Provider Details

I. General information

NPI: 1518453968
Provider Name (Legal Business Name): COTTONWOOD COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RIVERSIDE PLAZA LN NW STE 260
ALBUQUERQUE NM
87120-2160
US

IV. Provider business mailing address

6330 RIVERSIDE PLAZA LN NW STE 260
ALBUQUERQUE NM
87120-2160
US

V. Phone/Fax

Practice location:
  • Phone: 505-350-8452
  • Fax:
Mailing address:
  • Phone: 505-226-2839
  • 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: YVONNE E WILLIAMS
Title or Position: OWNER
Credential: MA, LPCC, RPT
Phone: 505-350-8452