Organization
SELF-DISCOVERY RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERASIMOS DEMOSTHENIS KLONIS LPCC (MANAGER)
(505) 603-8633
Entity
Organization
Contact information
Practice address
1052 MAIN ST NE, LOS LUNAS, NM 87031-7436
(505) 603-8633
Mailing address
2980 CLEAR SKY ST SW, LOS LUNAS, NM 87031-6453
(505) 603-8633
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19024576
—
NM
Enumeration date
10/20/2023
Last updated
01/14/2024
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