Healthcare Provider Details

I. General information

NPI: 1093171035
Provider Name (Legal Business Name): AWH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 DON GASPAR AVE
SANTA FE NM
87505-2626
US

IV. Provider business mailing address

532 DON GASPAR AVE
SANTA FE NM
87505-2626
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-9435
  • Fax:
Mailing address:
  • Phone: 505-660-9435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-08692
License Number StateNM

VIII. Authorized Official

Name: AMY WONG HOPE
Title or Position: CLINICAL SOCIAL WORKER
Credential: LISW
Phone: 505-660-9435