Healthcare Provider Details

I. General information

NPI: 1144099284
Provider Name (Legal Business Name): PAIGE ROSE BENNETT MA, LMHC, LADAC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KERSTINE GALLEGOS

II. Dates (important events)

Enumeration Date: 01/01/2024
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 PINEHURST RD SE
RIO RANCHO NM
87124-2568
US

IV. Provider business mailing address

918 PINEHURST RD SE STE 101
RIO RANCHO NM
87124-2568
US

V. Phone/Fax

Practice location:
  • Phone: 505-218-6383
  • Fax:
Mailing address:
  • Phone: 505-353-7926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2025-0319
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2025-0331
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCTB-2025-0517
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: