Provider Demographics
NPI:1699216119
Name:ADVENTURE IN FAITH COUNSELING, LLC
Entity Type:Organization
Organization Name:ADVENTURE IN FAITH COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATA-HARTSHORN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, PHD
Authorized Official - Phone:505-503-5978
Mailing Address - Street 1:1526 SIERRA NORTE LOOP NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-2520
Mailing Address - Country:US
Mailing Address - Phone:505-503-5978
Mailing Address - Fax:505-212-1873
Practice Address - Street 1:1815 LAS LOMAS RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3803
Practice Address - Country:US
Practice Address - Phone:505-503-5978
Practice Address - Fax:505-212-1873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0182901101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty