Organization
EARTH SPIRIT AWAKENINGS LLC
Active
Other names
Mesa Vista Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
TOD L DICECCO MA, LPCC (EXECUTIVE DIRECTOR/OWNER)
(505) 490-1984
Entity
Organization
Contact information
Practice address
4001 OFFICE COURT DR STE 102, SANTA FE, NM 87507-4903
(505) 983-8225
Mailing address
4001 OFFICE COURT DR, SUITE 102, SANTA FE, NM 87507-4929
(505) 983-8225
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0119891
NM
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81024371
—
NM
Enumeration date
02/25/2009
Last updated
02/10/2022
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up