Healthcare Provider Details

I. General information

NPI: 1285502203
Provider Name (Legal Business Name): GREEN CLIFF COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 MARQUEZ PL UNIT 211
SANTA FE NM
87505-1834
US

IV. Provider business mailing address

1000 CORDOVA PL
SANTA FE NM
87505-1725
US

V. Phone/Fax

Practice location:
  • Phone: 202-770-7064
  • Fax:
Mailing address:
  • Phone: 202-770-7064
  • Fax:

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: MATTHEW WAGNER
Title or Position: OWNER/CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 202-770-7064