| NPI | 1407580152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALITA G MALONEY Clinical Supervisor 505-792-6726 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YP2500X Counselor, Professional | |
| 103TC0700X Psychologist, Clinical | |
| Enumeration Date | 2022-07-10 |
| Last Update Date | 2022-07-10 |