Individual
PATRICK ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISAC
Contact information
Practice address
3930 N 30TH AVE, PHOENIX, AZ 85017-4607
(623) 322-6143
(480) 781-4566
Mailing address
3930 N 30TH AVE, PHOENIX, AZ 85017-4607
(623) 322-6143
(480) 781-4566
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15174
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
091903
—
AZ
Enumeration date
04/01/2022
Last updated
09/06/2022
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