Healthcare Provider Details

I. General information

NPI: 1134084023
Provider Name (Legal Business Name): SANDIA CREST AUTISM SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 RANDOLPH RD SE
ALBUQUERQUE NM
87106-4230
US

IV. Provider business mailing address

1801 RANDOLPH RD SE
ALBUQUERQUE NM
87106-4230
US

V. Phone/Fax

Practice location:
  • Phone: 575-644-3860
  • Fax:
Mailing address:
  • Phone: 575-644-3860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANDRA EMANUEL
Title or Position: CHIEF EXECUTIVE OFFICER/OWNER
Credential: LCSW
Phone: 575-644-3860