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Organization
EARTH SPIRIT AWAKENINGS
Active
Organization
EARTH SPIRIT AWAKENINGS
Active
Other names
dba Mesa Vista Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
TOD DICECCO LPCC (EXECUTIVE DIRECTOR)
(505) 983-8225
Entity
Organization
Contact information
Practice address
2019 GALISTEO ST, SANTA FE, NM 87505-2143
(505) 983-8225
(505) 930-5427
Mailing address
2019 GALISTEO ST, SANTA FE, NM 87505-2143
(505) 983-8225
(505) 930-5427
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1600129265
NM
Other
Enumeration date
07/07/2016
Last updated
07/07/2016
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