Healthcare Provider Details

I. General information

NPI: 1336558782
Provider Name (Legal Business Name): COUNSELING ABQ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 MENAUL BLVD NE SUITE B
ALBUQUERQUE NM
87110-3695
US

IV. Provider business mailing address

7001 MENAUL BLVD NE SUITE B
ALBUQUERQUE NM
87110-3695
US

V. Phone/Fax

Practice location:
  • Phone: 505-220-8512
  • Fax:
Mailing address:
  • Phone: 505-220-8512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-05056
License Number StateNM

VIII. Authorized Official

Name: DENISE DECKER
Title or Position: OWNER
Credential: LISW
Phone: 505-220-8512