Healthcare Provider Details

I. General information

NPI: 1821477852
Provider Name (Legal Business Name): WELLBEING COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 MENAUL BLVD. NE SUITE 102
ALBUQUERQUE NM
87110-2842
US

IV. Provider business mailing address

1021 ARIZONA ST SE
ALBUQUERQUE NM
87108-4827
US

V. Phone/Fax

Practice location:
  • Phone: 505-301-9997
  • Fax: 505-672-7916
Mailing address:
  • Phone: 505-918-6692
  • Fax: 505-672-7916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC-07338
License Number StateNM

VIII. Authorized Official

Name: MS. MARIE A. L. BRAMAN
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 505-301-9997