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General NPI Number Information
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NPI Number | 1912156654
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Entity Type | Organization
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Legal Business Name | TRANSFORMATIVE COUNSELING CENTER LLC
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 08/04/2014
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Provider Practice Location Address
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Address Line | 5111 SAN MATEO BLVD NE SUITE B-2
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-2412
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Country | US
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Telephone | 505-238-7468
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Fax |
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Provider Business Mailing Address
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Address Line | 737 LOMA PINON LOOP NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-0588
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Country | US
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Telephone | 505-238-7468
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | MS. DIANE C CHAVEZ
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Credential | MA, LPCC
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Telephone | 505-238-7468
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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 | 0105091
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License Number State | NM
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