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General NPI Number Information
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NPI Number | 1396027272
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL CONFIDENTIAL COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 09/15/2011
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 103A SAGAR DRIVE
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City | VANDERWAGEN
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State | NM
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Zip | 87326
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Country | US
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Telephone | 505-778-5151
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Fax | 505-778-5151
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | VANDERWAGEN
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State | NM
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Zip | 87326-0190
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Country | US
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Telephone | 505-778-5177
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Fax | 505-778-5151
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. SANDRA L SWEENEY
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Credential |
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Telephone | 505-778-5151
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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 | 0089971
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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 | 0086791
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I-05565
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I-2706
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License Number State | NM
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Taxonomy #5
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0109351
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License Number State | NM
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