Healthcare Provider Details

I. General information

NPI: 1659551893
Provider Name (Legal Business Name): CENTERPOINT CHILD & FAMILY SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BARBARA LOOP SE SUITE D
RIO RANCHO NM
87124-1088
US

IV. Provider business mailing address

3508 ELDER MEADOWS DR NE
RIO RANCHO NM
87144-0562
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-3064
  • Fax: 505-268-9390
Mailing address:
  • Phone: 505-268-3064
  • Fax: 505-268-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4094
License Number StateNM

VIII. Authorized Official

Name: MARY N. CARROL
Title or Position: PRESIDENT/OWNER
Credential: MS, LPCC
Phone: 505-268-3064