Organization
GREATER SANTA ROSA COUNCIL ON ALCOHOLISM
Active
Other names
Professional Counseling Associ, Professional Counseling Associates of New Mexico
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONAS MOYA (CHIEF EXECUTIVE OFFICER)
(505) 803-4955
Entity
Organization
Contact information
Practice address
1047 LAKE DR, SANTA ROSA, NM 88435-2561
(575) 472-5383
Mailing address
1047 LAKE DR, SANTA ROSA, NM 88435-2561
(575) 472-5383
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LISW1041C0700X
NM
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000A3588
—
NM
01
—
NM000217
VALUE OPTIONS
NM
Enumeration date
05/10/2007
Last updated
07/15/2025
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