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General NPI Number Information
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NPI Number | 1215961255
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Entity Type | Organization
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Legal Business Name | CHRISTIAN COUNSELING CENTER OF NEW MEXICO
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8205 SPAIN RD NE STE 106
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3155
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Country | US
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Telephone | 505-856-0300
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Fax | 505-856-7946
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Provider Business Mailing Address
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Address Line | 8205 SPAIN RD NE STE 106
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3155
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Country | US
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Telephone | 505-856-0300
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Fax | 505-856-7946
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | GARY L WEBB
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Credential | LPCC
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Telephone | 505-856-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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