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General NPI Number Information
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NPI Number | 1477276046
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Entity Type | Organization
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Legal Business Name | NEW MEXICO DREAM CENTER OF ALBUQUERQUE
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Dates
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Enumeration Date | 09/20/2022
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 126 GENERAL CHENNAULT ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-2515
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Country | US
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Telephone | 505-900-3833
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Fax | 505-212-6422
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Provider Business Mailing Address
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Address Line | 126 GENERAL CHENNAULT ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-2515
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Country | US
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Telephone | 505-900-3833
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Fax | 505-212-6422
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Authorized Official
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Title or Position | CEO
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Name | SHELLEY REPP
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Credential |
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Telephone | 505-217-5060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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