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General NPI Number Information
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NPI Number | 1275963555
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Entity Type | Organization
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Legal Business Name | A GREENLEAF COUNSELING, INC
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Dates
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Enumeration Date | 11/22/2013
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Last Update Date | 11/22/2013
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Provider Practice Location Address
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Address Line | 2626 CENTRAL AVE SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87104-1616
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Country | US
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Telephone | 505-514-8630
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Fax | 595-452-3448
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Provider Business Mailing Address
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Address Line | 1280 SUNSET RD SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87105-3726
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Country | US
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Telephone | 505-514-8630
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Fax | 505-452-3448
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Authorized Official
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Title or Position | COUNSELOR
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Name | MS. PATRICIA ALLAIRE
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Credential |
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Telephone | 505-514-8630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0123631
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License Number State | NM
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