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General NPI Number Information
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NPI Number | 1033230818
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Entity Type | Organization
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Legal Business Name | DRAGONFLY COUNSELING ASSOCIATES INC.
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 1110 PENNSYLVANIA ST NE SUITE B
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-7404
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Country | US
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Telephone | 505-265-0753
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Fax | 505-268-5722
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Provider Business Mailing Address
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Address Line | 1110 PENNSYLVANIA ST NE SUITE B
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-7404
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Country | US
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Telephone | 505-265-0753
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Fax | 505-268-5722
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | NICHOLE BREANNE DIAZ
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Credential | CSW
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Telephone | 505-265-0753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | I-4453
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License Number State | NM
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