Organization
AZOMALLI THERAPY AND GROWTH CENTER LLC
Active
Organization
AZOMALLI THERAPY AND GROWTH CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS DALIA MEDINA BUSTILLOS LCSW (OWNER)
(505) 267-7031
Entity
Organization
Contact information
Practice address
701 57TH ST NW, ALBUQUERQUE, NM 87105-1343
(505) 267-7031
Mailing address
701 57TH ST NW, ALBUQUERQUE, NM 87105-1343
(505) 267-7031
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
11/04/2024
Last updated
12/05/2024
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