Organization
SANDIA COUNSELING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY SHANE LPCC (CEO)
(505) 459-4647
Entity
Organization
Contact information
Practice address
8416 SONOMA VALLEY RD NE, ALBUQUERQUE, NM 87122-2626
(505) 459-4647
Mailing address
8416 SONOMA VALLEY RD NE, ALBUQUERQUE, NM 87122-2626
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3708741
—
NM
Enumeration date
09/18/2018
Last updated
09/18/2018
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