Provider Demographics
NPI:1366698839
Name:INNER WISDOM COUNSELING, L.L.C.
Entity type:Organization
Organization Name:INNER WISDOM COUNSELING, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAJJAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-306-4144
Mailing Address - Street 1:11005 SPAIN RD NE STE 10
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1871
Mailing Address - Country:US
Mailing Address - Phone:505-306-4144
Mailing Address - Fax:
Practice Address - Street 1:11005 SPAIN RD NE STE 10
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:505-306-4144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03143168002251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13784005Medicaid