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General NPI Number Information
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NPI Number | 1710623558
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Entity Type | Organization
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Legal Business Name | FAITH & GRACE THERAPEUTIC SERVICES AND CONSULTATION
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Dates
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Enumeration Date | 05/05/2022
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 4110 WOLCOTT AVE NE STE B
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4598
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Country | US
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Telephone | 505-331-3644
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Fax |
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Provider Business Mailing Address
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Address Line | 8100 WYOMING BLVD NE STE M4-363
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-1946
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Country | US
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Telephone | 505-331-3644
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINE ROSS
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Credential | PH.D.
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Telephone | 505-980-7219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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