Organization
MAQ ELE', LLC
Active
Other names
Black Canvas Wholistic Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MAQUEITA S ELEAZER MA, LPAT, ATR-BC (OWNER)
(505) 913-1641
Entity
Organization
Contact information
Practice address
1919 5TH ST STE O, SANTA FE, NM 87505-6012
(505) 913-1641
Mailing address
2800 S MEADOWS RD UNIT 435, SANTA FE, NM 87507-3680
(505) 913-1641
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
221700000X
Art Therapist
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Enumeration date
03/13/2023
Last updated
11/02/2023
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