Healthcare Provider Details

I. General information

NPI: 1346836244
Provider Name (Legal Business Name): ENGAGE AND IGNITE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 4TH ST NW SUITE 1
ALBUQUERQUE NM
87107
US

IV. Provider business mailing address

6303 4TH ST NW SUITE 1
ALBUQUERQUE NM
87107
US

V. Phone/Fax

Practice location:
  • Phone: 505-903-4413
  • Fax: 505-903-7183
Mailing address:
  • Phone: 505-903-4413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH K DANIELS
Title or Position: PRESIDENT/OWNER
Credential: LPCC
Phone: 505-903-4413