Provider Demographics
NPI:1366128381
Name:PEACE FOR JOY COUNSELING LLC
Entity type:Organization
Organization Name:PEACE FOR JOY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:DELUCA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:575-770-1733
Mailing Address - Street 1:2710 GALISTEO ROAD
Mailing Address - Street 2:APT B
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5666
Mailing Address - Country:US
Mailing Address - Phone:575-770-1733
Mailing Address - Fax:
Practice Address - Street 1:2710 GALISTEO RD APT B
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5666
Practice Address - Country:US
Practice Address - Phone:505-570-3837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM36951200Medicaid