Organization
KIM CANTRELL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM CANTRELL LISW (OWNER)
(505) 362-3515
Entity
Organization
Contact information
Practice address
2006 SOUTHERN BLVD SE STE 203C, RIO RANCHO, NM 87124-3758
(505) 362-3515
Mailing address
8205 SPAIN RD NE, SUITE 106, ALBUQUERQUE, NM 87109-3179
(505) 362-3515
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-06910
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
99976307
—
NM
Enumeration date
02/27/2013
Last updated
02/27/2013
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