Healthcare Provider Details

I. General information

NPI: 1558036327
Provider Name (Legal Business Name): AKA THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RIVERSIDE PLAZA LN NW STE 160
ALBUQUERQUE NM
87120-2682
US

IV. Provider business mailing address

6330 RIVERSIDE PLAZA LN NW STE 160
ALBUQUERQUE NM
87120-2682
US

V. Phone/Fax

Practice location:
  • Phone: 505-444-4127
  • Fax:
Mailing address:
  • Phone: 505-444-4127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. AFTON FISK SPARROW
Title or Position: CO-OWNER
Credential: LPCC, LPAT, ATR-BC
Phone: 505-633-8103