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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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