Healthcare Provider Details

I. General information

NPI: 1902267016
Provider Name (Legal Business Name): LA VIDA NUEVA COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 MENAUL BLVD NE SUITE C
ALBUQUERQUE NM
87112-2455
US

IV. Provider business mailing address

10900 MENAUL BLVD NE SUITE C
ALBUQUERQUE NM
87112-2455
US

V. Phone/Fax

Practice location:
  • Phone: 505-429-5007
  • Fax:
Mailing address:
  • Phone:
  • 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: MS. MARIA VIGIL
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 505-429-5007