Organization
KITCHEN TABLE COUNSELING PROFESSIONAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA GEARY LCSW (MEMBER)
(360) 433-7755
Entity
Organization
Contact information
Practice address
333 E JEFFERSON ST, GALLUP, NM 87301-5113
(360) 433-7755
Mailing address
333 E JEFFERSON ST, GALLUP, NM 87301-5113
(360) 433-7755
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
12/07/2020
Last updated
12/07/2020
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