Healthcare Provider Details

I. General information

NPI: 1861229569
Provider Name (Legal Business Name): PINON GROVE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 GARFIELD AVE SE STE 1
ALBUQUERQUE NM
87106-3696
US

IV. Provider business mailing address

2504 GARFIELD AVE SE STE 1
ALBUQUERQUE NM
87106-3696
US

V. Phone/Fax

Practice location:
  • Phone: 505-431-1500
  • Fax:
Mailing address:
  • Phone: 505-431-1500
  • 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: MR. GARRETT DEMKO
Title or Position: OWNER
Credential: LCSW
Phone: 717-606-9651