Healthcare Provider Details

I. General information

NPI: 1780903260
Provider Name (Legal Business Name): CATHANN DRAGONE-GUTIERREZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 CARLISLE BLVD NE STE 201D
ALBUQUERQUE NM
87110-5662
US

IV. Provider business mailing address

1420 CARLISLE BLVD NE STE 201D
ALBUQUERQUE NM
87110-5662
US

V. Phone/Fax

Practice location:
  • Phone: 505-307-1059
  • Fax:
Mailing address:
  • Phone: 505-307-1059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0131261
License Number StateNM

VIII. Authorized Official

Name: MRS. CATHANN DRAGONE-GUTIERREZ
Title or Position: DIRECTOR
Credential: LPCC
Phone: 505-307-1059