Healthcare Provider Details

I. General information

NPI: 1801093562
Provider Name (Legal Business Name): COMMUNITY AGAINST VIOLENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 SALAZAR ROAD
TAOS NM
87571
US

IV. Provider business mailing address

PO BOX 169
TAOS NM
87571-0169
US

V. Phone/Fax

Practice location:
  • Phone: 505-758-8082
  • Fax: 505-758-4051
Mailing address:
  • Phone: 505-758-8082
  • Fax: 505-758-4051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MALINDA DUNNAM
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-758-8082