Healthcare Provider Details

I. General information

NPI: 1285800185
Provider Name (Legal Business Name): COUNSELING WORLD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 WYOMING BLVD NE SUITE 101
ALBUQUERQUE NM
87112-1035
US

IV. Provider business mailing address

2601 WYOMING BLVD NE SUITE 101
ALBUQUERQUE NM
87112-1035
US

V. Phone/Fax

Practice location:
  • Phone: 505-404-0717
  • Fax: 505-999-1172
Mailing address:
  • Phone: 505-404-0717
  • Fax: 505-999-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-3387
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0091301
License Number StateNM

VIII. Authorized Official

Name: MR. ROGER A AGUIAR III
Title or Position: CEO
Credential: LPCC
Phone: 505-480-3577