Individual
SHANTELL DIVINITY MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1101 MEDICAL ARTS AVE NE, ALBUQUERQUE, NM 87102
(505) 933-4639
Mailing address
1101 MEDICAL ARTS AVE NE BLDG 3, ALBUQUERQUE, NM 87102-2706
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CTB20250475
NM
106S00000X
Behavior Technician
—
—
Other
Enumeration date
04/23/2018
Last updated
07/30/2025
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