Healthcare Provider Details

I. General information

NPI: 1144886623
Provider Name (Legal Business Name): ABSOLUTION ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 MARTHA ST NE
ALBUQUERQUE NM
87112-4362
US

IV. Provider business mailing address

PO BOX 11322
ALBUQUERQUE NM
87192-0322
US

V. Phone/Fax

Practice location:
  • Phone: 505-321-9828
  • Fax:
Mailing address:
  • Phone: 505-321-9828
  • Fax:

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: FAYETTE LYNN BARBOUR
Title or Position: OWNER/DIRECTOR
Credential: LCSW
Phone: 505-321-9828