Healthcare Provider Details

I. General information

NPI: 1265359384
Provider Name (Legal Business Name): SUPPORT 4 HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 CAMINO DE LA JARA
EL PRADO NM
87529-6040
US

IV. Provider business mailing address

1119 CAMINO DE LA JARA
EL PRADO NM
87529-6040
US

V. Phone/Fax

Practice location:
  • Phone: 505-795-4413
  • Fax:
Mailing address:
  • Phone: 505-795-4413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: HEIDI WAHL
Title or Position: OWNER
Credential:
Phone: 575-224-2072