Healthcare Provider Details

I. General information

NPI: 1225538317
Provider Name (Legal Business Name): NIZHONI COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11005 SPAIN RD NE STE 15
ALBUQUERQUE NM
87111-1871
US

IV. Provider business mailing address

2920 CARLISLE BLVD NE STE 106
ALBUQUERQUE NM
87110-2855
US

V. Phone/Fax

Practice location:
  • Phone: 505-715-9673
  • Fax:
Mailing address:
  • Phone: 505-715-9673
  • 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: MS. AUTUMN J DRAGS WOLF
Title or Position: PRESIDENT
Credential: LCSW
Phone: 505-715-9673