Healthcare Provider Details

I. General information

NPI: 1487576815
Provider Name (Legal Business Name): D.L.W. FORENSIC COMMUNITY NAVIGATION SPECIALIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 ASPEN AVE NE APT 25
ALBUQUERQUE NM
87110-5651
US

IV. Provider business mailing address

3803 ASPEN AVE NE APT 25
ALBUQUERQUE NM
87110-5651
US

V. Phone/Fax

Practice location:
  • Phone: 505-238-4257
  • Fax: 505-238-4257
Mailing address:
  • Phone: 505-238-4257
  • Fax: 505-238-4257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DEMETRE WALLACE
Title or Position: CEO/MANAGING MEMBER
Credential: CCHW,CCSS
Phone: 505-238-4257