Healthcare Provider Details

I. General information

NPI: 1053820902
Provider Name (Legal Business Name): SUPPORT IS APPARENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 GAUDIAN LOOP
SANDIA PARK NM
87047-9555
US

IV. Provider business mailing address

11600 HAINES AVE NE
ALBUQUERQUE NM
87112-4452
US

V. Phone/Fax

Practice location:
  • Phone: 505-620-2119
  • Fax: 505-445-4504
Mailing address:
  • Phone: 505-620-2119
  • Fax: 505-445-4504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ADRIANNA GALLEGOS
Title or Position: OWNER/PROVIDER
Credential: LCSW
Phone: 505-226-1800