Healthcare Provider Details

I. General information

NPI: 1497120422
Provider Name (Legal Business Name): SECOND CREATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 OLD PECOS TRL STE P
SANTA FE NM
87505-4759
US

IV. Provider business mailing address

1800 OLD PECOS TRL STE P
SANTA FE NM
87505-4759
US

V. Phone/Fax

Practice location:
  • Phone: 505-795-8447
  • Fax: 505-213-0337
Mailing address:
  • Phone: 505-795-8447
  • Fax: 505-213-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0161941
License Number StateNM

VIII. Authorized Official

Name: MS. ALEXANDRA E PITT
Title or Position: CEO
Credential: LPCC
Phone: 505-795-8447