Healthcare Provider Details

I. General information

NPI: 1396490462
Provider Name (Legal Business Name): CORAZON COUNSELING AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6212 CASA BLANCA NW
ALBUQUERQUE NM
87120-3190
US

IV. Provider business mailing address

6212 CASA BLANCA NW
ALBUQUERQUE NM
87120-3190
US

V. Phone/Fax

Practice location:
  • Phone: 505-363-7495
  • Fax:
Mailing address:
  • Phone: 505-363-7495
  • 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: ERICA DENISE ORTIZ
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 505-363-7495