Healthcare Provider Details

I. General information

NPI: 1851119549
Provider Name (Legal Business Name): GAIA SPIRIT COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3824 PITT ST NE
ALBUQUERQUE NM
87111-3519
US

IV. Provider business mailing address

3824 PITT ST NE
ALBUQUERQUE NM
87111-3519
US

V. Phone/Fax

Practice location:
  • Phone: 505-382-3332
  • Fax:
Mailing address:
  • Phone: 505-382-3332
  • 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: VANESSA D PALMER
Title or Position: GREATER THAN DIRECT OWNER
Credential: LCSW
Phone: 505-382-3332