Provider Demographics
NPI:1225538317
Name:NIZHONI COUNSELING
Entity type:Organization
Organization Name:NIZHONI COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRAGS WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-715-9673
Mailing Address - Street 1:2920 CARLISLE BLVD NE STE 106
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-2855
Mailing Address - Country:US
Mailing Address - Phone:505-715-9673
Mailing Address - Fax:
Practice Address - Street 1:11005 SPAIN RD NE STE 15
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1871
Practice Address - Country:US
Practice Address - Phone:505-715-9673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty