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General NPI Number Information
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NPI Number | 1770293862
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Entity Type | Individual
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Provider Name | ABIGAIL GRACE PETERSON
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Gender | Female
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 901 RIO GRANDE BLVD NW STE G252
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City | ALBUQUERQUE
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State | NM
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Zip | 87104-2050
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Country | US
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Telephone | 505-702-8112
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Fax |
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Provider Business Mailing Address
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Address Line | 10331 DUNBAR ST NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5522
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Country | US
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Telephone | 505-573-4242
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CTB-2024-0293
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License Number State | NM
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