Organization
NEUROGENESIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA DAHLIN MA, LPCC (OWNER)
(575) 654-2919
Entity
Organization
Contact information
Practice address
613 CANYON RD, SANTA FE, NM 87501-2721
(575) 654-2919
Mailing address
613 CANYON RD, SANTA FE, NM 87501-2721
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
12/06/2016
Last updated
12/06/2016
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