Healthcare Provider Details

I. General information

NPI: 1487260964
Provider Name (Legal Business Name): NEW MEXICO GUIDED HEALING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2020
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 GRANDE BLVD SE STE E-13
RIO RANCHO NM
87124-1799
US

IV. Provider business mailing address

PO BOX 93985
ALBUQUERQUE NM
87199-3985
US

V. Phone/Fax

Practice location:
  • Phone: 505-492-5964
  • Fax: 505-441-2662
Mailing address:
  • Phone:
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. CATIANE KAMAL-ALDEEN
Title or Position: CLINICAL DIRECTOR
Credential: LCSW, LADAC
Phone: 505-492-5964