Individual
STACI DETWILER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
4646 E GREENWAY RD STE 100, PHOENIX, AZ 85032-4805
(480) 674-9220
(480) 674-9231
Mailing address
3334 E GELDING DR, PHOENIX, AZ 85032-5352
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-22553
AZ
Other
Enumeration date
07/20/2022
Last updated
02/19/2025
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