Provider Demographics
NPI:1538506092
Name:UNA NUEVA VIDA COUNSELING,LLC
Entity Type:Organization
Organization Name:UNA NUEVA VIDA COUNSELING,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPCC
Authorized Official - Prefix:MR
Authorized Official - First Name:ARCHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-266-9393
Mailing Address - Street 1:532 ADAMS ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1229
Mailing Address - Country:US
Mailing Address - Phone:505-265-9393
Mailing Address - Fax:505-266-6130
Practice Address - Street 1:532 ADAMS ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1229
Practice Address - Country:US
Practice Address - Phone:505-265-9393
Practice Address - Fax:505-266-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1348251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health