| NPI | 1972626463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE ELDEN DETTWEILER Manager 505-603-0641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 4706) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2020-08-22 |