Healthcare Provider Details

I. General information

NPI: 1447873757
Provider Name (Legal Business Name): HEALING PATHWAYS PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 ALAMEDA BLVD NE
ALBUQUERQUE NM
87113-1569
US

IV. Provider business mailing address

1264 PEPPOLI LOOP SE
RIO RANCHO NM
87124-8782
US

V. Phone/Fax

Practice location:
  • Phone: 505-712-2190
  • Fax:
Mailing address:
  • Phone:
  • 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: DANIELLE JULIET FICHERA
Title or Position: OWNER/ LCSW
Credential:
Phone: 505-712-2190