Provider Demographics
NPI:1558819847
Name:ABC SOCIAL WORK AND COUNSELING
Entity Type:Organization
Organization Name:ABC SOCIAL WORK AND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-991-0800
Mailing Address - Street 1:157 LYNWOOD DR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3969
Mailing Address - Country:US
Mailing Address - Phone:505-991-0800
Mailing Address - Fax:
Practice Address - Street 1:157 LYNWOOD DR SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3969
Practice Address - Country:US
Practice Address - Phone:505-991-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2017-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-08014251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM39132358Medicaid