Healthcare Provider Details

I. General information

NPI: 1578025110
Provider Name (Legal Business Name): MERAKI WELL-BEING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 ROLLING RIDGE DR SW
ALBUQUERQUE NM
87121-5357
US

IV. Provider business mailing address

2001 ROLLING RIDGE DR SW
ALBUQUERQUE NM
87121-5357
US

V. Phone/Fax

Practice location:
  • Phone: 505-859-6378
  • Fax:
Mailing address:
  • Phone: 505-859-6378
  • 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: MICHELE M DONOVAN
Title or Position: OWNER
Credential: LCSW
Phone: 505-859-6378