Healthcare Provider Details

I. General information

NPI: 1427599356
Provider Name (Legal Business Name): INTENTIONAL PATH COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2017
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 WASHINGTON ST SE
ALBUQUERQUE NM
87108-2735
US

IV. Provider business mailing address

PO BOX 4642
ALBUQUERQUE NM
87196-4642
US

V. Phone/Fax

Practice location:
  • Phone: 505-980-0954
  • Fax:
Mailing address:
  • Phone: 505-980-0954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09065
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: VANYA GARABEDIAN
Title or Position: OWNER
Credential: LCSW
Phone: 505-980-0954