Provider Demographics
NPI:1407580152
Name:SOCORRO COUNTY COMMUNITY ALTERNATIVES PROGRAM
Entity Type:Organization
Organization Name:SOCORRO COUNTY COMMUNITY ALTERNATIVES PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALITA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-792-6726
Mailing Address - Street 1:106 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-4559
Mailing Address - Country:US
Mailing Address - Phone:505-792-6726
Mailing Address - Fax:
Practice Address - Street 1:106 CENTER ST
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-4559
Practice Address - Country:US
Practice Address - Phone:505-792-6726
Practice Address - Fax:575-838-0244
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SOCORRO, NM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty