Healthcare Provider Details

I. General information

NPI: 1033230818
Provider Name (Legal Business Name): DRAGONFLY COUNSELING ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 11/26/2024
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 PENNSYLVANIA ST NE SUITE B
ALBUQUERQUE NM
87110-7404
US

IV. Provider business mailing address

1110 PENNSYLVANIA ST NE SUITE B
ALBUQUERQUE NM
87110-7404
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-0753
  • Fax: 505-268-5722
Mailing address:
  • Phone: 505-265-0753
  • Fax: 505-268-5722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberI-4453
License Number StateNM

VIII. Authorized Official

Name: NICHOLE BREANNE DIAZ
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: CSW
Phone: 505-265-0753