Organization
CHILDRENS PSYCHIATRIC CENTER OUTPATIENT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DWIGHT RANDOLPH COLEMAN JR. (MENTAL HEALTH ASSOCIATE)
(505) 710-1826
Entity
Organization
Contact information
Practice address
2600 MARBLE AVE NE BLDG 2, ALBUQUERQUE, NM 87106-2058
(505) 272-2190
(505) 272-3466
Mailing address
2600 MARBLE AVE NE BLDG 2, ALBUQUERQUE, NM 87106-2058
(505) 272-2190
(505) 272-3466
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
12/12/2012
Last updated
12/12/2012
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