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General NPI Number Information
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NPI Number | 1467319780
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Entity Type | Organization
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Legal Business Name | CENTRACARE WELLNESS & PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 01/08/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 717 ENCINO PL NE STE 6
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2624
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Country | US
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Telephone | 210-214-3865
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Fax |
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Provider Business Mailing Address
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Address Line | 401 MISSION ARCH DR
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City | ROSWELL
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State | NM
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Zip | 88201-6792
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Country | US
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Telephone | 210-214-3865
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LYDIA CARTER
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Credential | PMHNP-BC
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Telephone | 210-214-3865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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