Provider Demographics
NPI:1093171035
Name:AWH LLC
Entity Type:Organization
Organization Name:AWH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:WONG
Authorized Official - Last Name:HOPE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-660-9435
Mailing Address - Street 1:532 DON GASPAR AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2626
Mailing Address - Country:US
Mailing Address - Phone:505-660-9435
Mailing Address - Fax:
Practice Address - Street 1:532 DON GASPAR AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2626
Practice Address - Country:US
Practice Address - Phone:505-660-9435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-086921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty