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General NPI Number Information
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NPI Number | 1477507069
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Entity Type | Organization
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Legal Business Name | RIO GRANDE COUNSELING & GUIDANCE SERVICES, PA
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1010 LAS LOMAS RD NE SUITE 4
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2634
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Country | US
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Telephone | 505-246-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 2132 CENTRAL AVE SE SUITE 249
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4083
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Country | US
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Telephone | 505-259-7769
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JT CARRILLO
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Credential | LISW
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Telephone | 505-259-7769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I-04891
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License Number State | NM
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