Provider Demographics
NPI:1447427182
Name:AGAPE COUNSELING SERVICES OF ALBUQUERQUE INC.
Entity Type:Organization
Organization Name:AGAPE COUNSELING SERVICES OF ALBUQUERQUE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:FLORINDA
Authorized Official - Last Name:ELWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:505-249-0021
Mailing Address - Street 1:8004 PONY HILLS PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6083
Mailing Address - Country:US
Mailing Address - Phone:505-249-0021
Mailing Address - Fax:
Practice Address - Street 1:5415 FORTUNA RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-1371
Practice Address - Country:US
Practice Address - Phone:505-249-0021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-06402251S00000X
NMI-3639251S00000X
NM0095611251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health