1821477852 NPI number — WELLBEING COUNSELING CENTER, LLC

Table of content: DR. KINA CHARON PEPPERS M.D. (NPI 1316975295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821477852 NPI number — WELLBEING COUNSELING CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLBEING COUNSELING CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821477852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1021 ARIZONA ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87108-4827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-918-6692
Provider Business Mailing Address Fax Number:
505-672-7916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3636 MENAUL BLVD. NE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87110-2842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-301-9997
Provider Business Practice Location Address Fax Number:
505-672-7916
Provider Enumeration Date:
05/22/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BRAMAN
Authorized Official First Name:
MARIE
Authorized Official Middle Name:
A. L.
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
505-301-9997

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  C-07338 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 89239814 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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