Organization
RIO GRANDE COUNSELING & GUIDANCE SERVICES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JT CARRILLO LISW (CEO)
(505) 259-7769
Entity
Organization
Contact information
Practice address
1010 LAS LOMAS RD NE, SUITE 4, ALBUQUERQUE, NM 87102-2634
(505) 246-8700
Mailing address
2132 CENTRAL AVE SE, SUITE 249, ALBUQUERQUE, NM 87106-4083
(505) 259-7769
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-04891
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40136728
—
NM
Enumeration date
05/19/2006
Last updated
08/22/2020
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