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General NPI Number Information
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NPI Number | 1497120422
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Entity Type | Organization
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Legal Business Name | SECOND CREATION INC.
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Dates
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Enumeration Date | 12/02/2015
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 1800 OLD PECOS TRL STE P
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City | SANTA FE
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State | NM
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Zip | 87505-4759
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Country | US
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Telephone | 505-795-8447
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Fax | 505-213-0337
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Provider Business Mailing Address
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Address Line | 1800 OLD PECOS TRL STE P
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City | SANTA FE
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State | NM
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Zip | 87505-4759
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Country | US
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Telephone | 505-795-8447
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Fax | 505-213-0337
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Authorized Official
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Title or Position | CEO
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Name | MS. ALEXANDRA E PITT
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Credential | LPCC
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Telephone | 505-795-8447
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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 | 0161941
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License Number State | NM
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