Provider Demographics
NPI:1336178060
Name:AGE TO AGE COUNSELING PC
Entity Type:Organization
Organization Name:AGE TO AGE COUNSELING PC
Other - Org Name:AGE TO AGE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAIGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-291-6314
Mailing Address - Street 1:5916 ANAHEIM AVE NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1894
Mailing Address - Country:US
Mailing Address - Phone:505-291-6314
Mailing Address - Fax:505-275-0296
Practice Address - Street 1:5916 ANAHEIM AVE NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1894
Practice Address - Country:US
Practice Address - Phone:505-291-6314
Practice Address - Fax:505-275-0296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0090661101Y00000X, 101Y00000X
NM0084431101Y00000X
NM0078161101Y00000X
NM0093081101Y00000X
NM0065462101YA0400X
NM0090291101YA0400X
NM0078051101YM0800X
NM0073851101YM0800X
NM0067362101YM0800X
NM0069871101YM0800X
NM0899103T00000X
NMI04889104100000X
NM0086431106H00000X
NM0138106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM28008367Medicaid