Healthcare Provider Details

I. General information

NPI: 1730554304
Provider Name (Legal Business Name): ATHENA COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 BROADMOOR BLVD NE STE E
RIO RANCHO NM
87124-3442
US

IV. Provider business mailing address

1380 RIO RANCHO DR SE # 432
RIO RANCHO NM
87124-1006
US

V. Phone/Fax

Practice location:
  • Phone: 505-565-7949
  • Fax: 877-440-8944
Mailing address:
  • Phone: 505-565-7949
  • Fax: 877-440-8944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0158231
License Number StateNM

VIII. Authorized Official

Name: MS. JILL H GRIGGS
Title or Position: OWNER
Credential: MA, LPCC, NCC
Phone: 505-565-7949