Healthcare Provider Details

I. General information

NPI: 1780394122
Provider Name (Legal Business Name): INTERSECTIONAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4616 PRAIRIE VIEW RD NW
ALBUQUERQUE NM
87120-2524
US

IV. Provider business mailing address

4616 PRAIRIE VIEW RD NW
ALBUQUERQUE NM
87120-2524
US

V. Phone/Fax

Practice location:
  • Phone: 505-900-4407
  • Fax: 505-372-0013
Mailing address:
  • Phone: 505-900-4407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TORI SCHWEIGER
Title or Position: OWNER
Credential: RN
Phone: 505-900-4407