Healthcare Provider Details

I. General information

NPI: 1265935035
Provider Name (Legal Business Name): ACCEPTANCE AND HEALING INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3916 AUGUSTA DR SE
RIO RANCHO NM
87124-8246
US

IV. Provider business mailing address

3916 AUGUSTA DR SE
RIO RANCHO NM
87124-8246
US

V. Phone/Fax

Practice location:
  • Phone: 505-903-9510
  • Fax:
Mailing address:
  • Phone: 505-903-9510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number1800016775
License Number StateNM

VIII. Authorized Official

Name: STACEY DEMAREY
Title or Position: CO-OWNER
Credential: LCSW
Phone: 505-903-9510