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Organization
NEW MEXICO TEEN CHALLENGE, INC.
Active
Organization
NEW MEXICO TEEN CHALLENGE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES GOINS JR. (CLINICAL SUPERVISOR)
(484) 868-0584
Entity
Organization
Contact information
Practice address
1 CAMINO ORO CT, TIJERAS, NM 87059-7924
(706) 596-8731
(706) 596-8732
Mailing address
PO BOX 20610, ALBUQUERQUE, NM 87154-0610
(706) 596-8731
(706) 596-8732
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
NULL
Other
Enumeration date
05/12/2020
Last updated
07/07/2023
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