Healthcare Provider Details

I. General information

NPI: 1023574019
Provider Name (Legal Business Name): MARCELLA AVILA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 03/21/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 W WASHINGTON AVE
LOVINGTON NM
88260-4023
US

IV. Provider business mailing address

1313 S 6TH ST
LOVINGTON NM
88260-5446
US

V. Phone/Fax

Practice location:
  • Phone: 575-739-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSWB-2024-1277
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: