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General NPI Number Information
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NPI Number | 1427467547
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Entity Type | Organization
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Legal Business Name | ALBUQUERQUE GUIDANCE CENTER
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 12/12/2017
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Provider Practice Location Address
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Address Line | 601 LOVEJOY RD SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87105-3849
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Country | US
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Telephone | 505-750-8866
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Fax | 707-444-8368
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Provider Business Mailing Address
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Address Line | 2741 INDIAN SCHOOL RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2653
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Country | US
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Telephone | 505-750-8866
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Fax | 505-444-8368
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Authorized Official
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Title or Position | CEO/CLINICAL DIRECTOR
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Name | CHARMAINE D LOPEZ
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Credential | LPCC
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Telephone | 505-750-8866
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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 | FA0098824
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License Number State | NM
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