Provider Demographics
NPI:1346641545
Name:MANOS DE DIOS
Entity Type:Organization
Organization Name:MANOS DE DIOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:ASHCROFT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC/LADAC
Authorized Official - Phone:505-402-4228
Mailing Address - Street 1:420 CHEROKEE RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3513
Mailing Address - Country:US
Mailing Address - Phone:505-402-4228
Mailing Address - Fax:505-877-0873
Practice Address - Street 1:318 ISLETA BLVD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-3822
Practice Address - Country:US
Practice Address - Phone:505-402-4228
Practice Address - Fax:505-877-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM065332101YA0400X
NM0071091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty