Healthcare Provider Details

I. General information

NPI: 1518485812
Provider Name (Legal Business Name): WINDSONG COUNSELING & CONSULTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 09/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9426 INDIAN SCHOOL RD NE STE 1
ALBUQUERQUE NM
87112-2887
US

IV. Provider business mailing address

208 SANGRE DE CRISTO
CEDAR CREST NM
87008-9525
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-6100
  • Fax:
Mailing address:
  • Phone: 347-837-2501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number1381
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1381
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1381
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1381
License Number StateNM

VIII. Authorized Official

Name: DR. LARISSA A MALEY
Title or Position: OWNER
Credential: PH.D.
Phone: 347-837-2501