Healthcare Provider Details

I. General information

NPI: 1285580092
Provider Name (Legal Business Name): SARAH CONSTANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 PALACIO DEL RIO GRANDE NW
ALBUQUERQUE NM
87107-3024
US

IV. Provider business mailing address

3808 PALACIO DEL RIO GRANDE NW
ALBUQUERQUE NM
87107-3024
US

V. Phone/Fax

Practice location:
  • Phone: 505-288-1517
  • Fax:
Mailing address:
  • Phone: 505-288-1517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SARAH CONSTANCE JOHNSON
Title or Position: CLINICIAN
Credential: LCSW
Phone: 505-288-1517