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Organization

POSITIVE CHANGE COUNSELING, LLC

Active
Other names
Shannon M. Burke, LPCC
Organization subpart
No

Provider details

NPI number
Authorized official
MS. SHANNON MARIE BURKE LPCC (OWNER)
(505) 220-6971
Entity
Organization

Contact information

Practice address
1209 ROUTE 66, MORIARTY, NM 87035
(505) 220-6971
(505) 832-4441
Mailing address
21 DINGO RD, MORIARTY, NM 87035-5498
(505) 220-6971
(505) 832-4441

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0156191
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
23372788
NM
Enumeration date
02/09/2017
Last updated
03/16/2017
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