Healthcare Provider Details

I. General information

NPI: 1144235797
Provider Name (Legal Business Name): FIRESPIRIT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6612 TERRA DOLCE AVE NW
ALBUQUERQUE NM
87114-1365
US

IV. Provider business mailing address

6612 TERRA DOLCE AVE NW
ALBUQUERQUE NM
87114-1365
US

V. Phone/Fax

Practice location:
  • Phone: 505-898-9942
  • Fax: 505-898-7176
Mailing address:
  • Phone: 505-898-9942
  • Fax: 505-898-7176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. DIANE GARCIA
Title or Position: PRESIDENT
Credential: PHD
Phone: 505-898-9942