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General NPI Number Information
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NPI Number | 1699188995
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Entity Type | Individual
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Provider Name | INA TOWNLEY BAWAYA LCSW, MFA
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Gender | Female
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Dates
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Enumeration Date | 06/04/2014
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 3901 GEORGIA ST NE STE A4
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-1391
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Country | US
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Telephone | 505-803-7150
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Fax | 505-293-0617
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Provider Business Mailing Address
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Address Line | 12820 THOMTE RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-6808
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Country | US
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Telephone | 505-293-2768
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | C-08584
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License Number State | NM
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