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General NPI Number Information
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NPI Number | 1972916153
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Entity Type | Organization
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Legal Business Name | A NEW LIFE STYLE, LLC
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 06/05/2014
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Provider Practice Location Address
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Address Line | 532 ADAMS ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-1229
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Country | US
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Telephone | 505-265-9393
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Fax | 505-266-6130
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Provider Business Mailing Address
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Address Line | 532 ADAMS ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-1229
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Country | US
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Telephone | 505-265-9393
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Fax | 505-266-6130
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Authorized Official
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Title or Position | DIRECTOR/CEO
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Name | ARCHIE GRINE
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Credential | LPCC
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Telephone | 505-265-9393
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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