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General NPI Number Information
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NPI Number | 1144235797
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Entity Type | Organization
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Legal Business Name | FIRESPIRIT, INC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 08/22/2010
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Provider Practice Location Address
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Address Line | 6612 TERRA DOLCE AVE NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-1365
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Country | US
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Telephone | 505-898-9942
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Fax | 505-898-7176
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Provider Business Mailing Address
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Address Line | 6612 TERRA DOLCE AVE NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-1365
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Country | US
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Telephone | 505-898-9942
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Fax | 505-898-7176
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DIANE GARCIA
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Credential | PHD
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Telephone | 505-898-9942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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