Healthcare Provider Details

I. General information

NPI: 1588320576
Provider Name (Legal Business Name): SANDIA THERAPY AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2021
Last Update Date: 11/13/2021
Certification Date: 11/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11005 SPAIN RD NE STE 15
ALBUQUERQUE NM
87111-1871
US

IV. Provider business mailing address

PO BOX 67216
ALBUQUERQUE NM
87193-7216
US

V. Phone/Fax

Practice location:
  • Phone: 217-419-0807
  • Fax:
Mailing address:
  • Phone: 217-419-0807
  • 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: MS. CHLOE EDGAR
Title or Position: CEO
Credential: LCSW
Phone: 217-419-0807