NPI | 1285086769 |
---|---|
Doing Business As | DBA MESA VISTA WELLNESS |
Entity Type | Organization |
Authorized Contact | TOD DICECCO Executive Director 505-983-8225 |
Organization Subpart ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 1600129265) |
Enumeration Date | 2016-07-07 |
Last Update Date | 2016-07-07 |