Healthcare Provider Details

I. General information

NPI: 1114589322
Provider Name (Legal Business Name): COUNSELING CONNECTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 ISTLE RD NE
RIO RANCHO NM
87124
US

IV. Provider business mailing address

1380 RIO RANCHO DR SE # 329
RIO RANCHO NM
87124-1006
US

V. Phone/Fax

Practice location:
  • Phone: 505-289-0198
  • Fax:
Mailing address:
  • Phone: 505-289-0198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARCIA FILIPIAK
Title or Position: PSYCHOTHERAPIST
Credential:
Phone: 505-289-0198