Healthcare Provider Details

I. General information

NPI: 1962934620
Provider Name (Legal Business Name): AFFIRMING HEART VICTIM SERVICES DBA CAVERN CITY CHILD ADVOCACY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 W PIERCE ST
CARLSBAD NM
88220-3515
US

IV. Provider business mailing address

PO BOX 1441
CARLSBAD NM
88221-1441
US

V. Phone/Fax

Practice location:
  • Phone: 575-200-3929
  • Fax:
Mailing address:
  • Phone: 575-200-3929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: MRS. ZELMA M LOPEZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 575-200-3929