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General NPI Number Information
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NPI Number | 1558762245
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Entity Type | Organization
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Legal Business Name | SAGE ADDICTION TREATMENT SERVICES
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Dates
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Enumeration Date | 09/12/2014
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Last Update Date | 09/12/2014
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Provider Practice Location Address
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Address Line | 2929 COORS BLVD NW STE 100D
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-1272
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Country | US
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Telephone | 505-977-9180
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Fax |
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Provider Business Mailing Address
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Address Line | 2929 COORS BLVD NW STE 100D
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-1272
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Country | US
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Telephone | 505-977-9180
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/CLINICAL PSYCHOLOGIST
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Name | DR. MARK S SIMPSON
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Credential | CLINICAL PSYCHOLOGIS
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Telephone | 505-977-9180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 0930
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License Number State | NM
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