Provider Demographics
NPI:1508424987
Name:NEW MEXICO CENTER FOR EMPOWERMENT AND MOOD SUPPORT LLC
Entity Type:Organization
Organization Name:NEW MEXICO CENTER FOR EMPOWERMENT AND MOOD SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED CLINICAL SOCIAL WORK
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUBACH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-401-0520
Mailing Address - Street 1:530B HARKLE RD # 100
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4739
Mailing Address - Country:US
Mailing Address - Phone:505-401-0520
Mailing Address - Fax:
Practice Address - Street 1:11930 MENAUL BLVD NE STE 220A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2461
Practice Address - Country:US
Practice Address - Phone:505-401-0520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty