Provider Demographics
NPI:1821520206
Name:SABRINA GASKILL LICENSED CLINICAL WORKER LC LLC
Entity Type:Organization
Organization Name:SABRINA GASKILL LICENSED CLINICAL WORKER LC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GASKILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:575-461-7909
Mailing Address - Street 1:518 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-2270
Mailing Address - Country:US
Mailing Address - Phone:575-461-7909
Mailing Address - Fax:
Practice Address - Street 1:706 S 1ST ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-2715
Practice Address - Country:US
Practice Address - Phone:575-461-8783
Practice Address - Fax:575-461-9624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-097831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM90952774Medicaid