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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