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Organization
CHILDRENS PSYCHIATRIC CENTER OUTPATIENT SERVICES
Active
Organization
CHILDRENS PSYCHIATRIC CENTER OUTPATIENT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DWIGHT RANDOLPH COLEMAN JR. (MENTAL HEALTH ASSOCIATE)
(505) 710-1826
Entity
Organization
Contact information
Practice address
2600 MARBLE AVE NE BLDG 2, ALBUQUERQUE, NM 87106-2058
(505) 272-2190
(505) 272-3466
Mailing address
2600 MARBLE AVE NE BLDG 2, ALBUQUERQUE, NM 87106-2058
(505) 272-2190
(505) 272-3466
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
12/12/2012
Last updated
12/12/2012
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