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General NPI Number Information
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NPI Number | 1134084023
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Entity Type | Organization
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Legal Business Name | SANDIA CREST AUTISM SERVICES, LLC
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 1801 RANDOLPH RD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4230
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Country | US
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Telephone | 575-644-3860
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 RANDOLPH RD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4230
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Country | US
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Telephone | 575-644-3860
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER/OWNER
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Name | MRS. SANDRA EMANUEL
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Credential | LCSW
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Telephone | 575-644-3860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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