| Agate Dynamics, Llc | |
|
1201 Eubank Blvd Ne Ste 1 Albuquerque NM 87112-5300 | |
| (505) 361-1958 | |
| (505) 369-1951 |
| Full Name | Agate Dynamics, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1201 Eubank Blvd Ne Ste 1, Albuquerque, New Mexico |
| Authorized Official Name and Position | Michelle Ault (OWNER) |
| Authorized Official Contact | 5053611958 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Agate Dynamics, Llc 1201 Eubank Blvd Ne Ste 1 Albuquerque NM 87112-5300 Ph: (505) 361-1958 | Agate Dynamics, Llc 1201 Eubank Blvd Ne Ste 1 Albuquerque NM 87112-5300 Ph: (505) 361-1958 |
| NPI Number | 1912404328 |
|---|---|
| Provider Enumeration Date | 04/11/2018 |
| Last Update Date | 04/11/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912404328 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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