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General NPI Number Information
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NPI Number | 1346641545
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Entity Type | Organization
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Legal Business Name | MANOS DE DIOS
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Dates
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Enumeration Date | 09/08/2014
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 318 ISLETA BLVD SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87105-3822
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Country | US
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Telephone | 505-402-4228
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Fax | 505-877-0873
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Provider Business Mailing Address
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Address Line | 420 CHEROKEE RD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-3513
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Country | US
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Telephone | 505-402-4228
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Fax | 505-877-0873
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Authorized Official
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Title or Position | OWNER/ PROVIDER
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Name | MS. SUSY KAY ASHCROFT
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Credential | MA, LPCC/LADAC
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Telephone | 505-402-4228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 065332
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0071091
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License Number State | NM
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