Healthcare Provider Details

I. General information

NPI: 1477300432
Provider Name (Legal Business Name): MIDDLE WAY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7558 KACHINA LOOP
SANTA FE NM
87507-4042
US

IV. Provider business mailing address

7558 KACHINA LOOP
SANTA FE NM
87507-4042
US

V. Phone/Fax

Practice location:
  • Phone: 518-428-6881
  • Fax:
Mailing address:
  • Phone: 518-428-6881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: HEATHER DAWN HINES
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 518-428-6881