Individual
MISS SHANNA CULLEN-CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MFT
Contact information
Practice address
100 SUN AVE NE STE 650, ALBUQUERQUE, NM 87109-4670
(909) 790-8603
(909) 790-8618
Mailing address
100 SUN AVE NE, ALBUQUERQUE, NM 87109-4659
(505) 376-9077
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
49429
CA
106H00000X
Marriage & Family Therapist
Primary
T-CTL0212371
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
330489658
TAX ID #
CA
Enumeration date
03/12/2007
Last updated
10/23/2020
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