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General NPI Number Information
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NPI Number | 1164634374
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Entity Type | Organization
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Legal Business Name | HILLSIDE COMMUNITY CHURCH
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 435 JEFFERSON SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108
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Country | US
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Telephone | 505-254-2606
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Fax |
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Provider Business Mailing Address
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Address Line | 435 JEFFERSON SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108
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Country | US
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Telephone | 505-254-2606
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE MINISTER COUNSELING PROG
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Name | DR. SUSAN CORREU NETTLE
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Credential | MD MINISTER
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Telephone | 505-254-2606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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