Healthcare Provider Details

I. General information

NPI: 1457155475
Provider Name (Legal Business Name): ALBUQUERQUE CONSCIOUS CONNECTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DOROTHY ST NE
ALBUQUERQUE NM
87112-3223
US

IV. Provider business mailing address

PO BOX 23205
ALBUQUERQUE NM
87192-1205
US

V. Phone/Fax

Practice location:
  • Phone: 505-688-3612
  • Fax: 505-688-3612
Mailing address:
  • Phone: 505-688-3612
  • 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: MARTHA CUMMINS-BELL
Title or Position: CEO
Credential: LCSW
Phone: 505-688-3612