Individual
LA TORIA WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISAC
Contact information
Practice address
10220 N 31ST AVE STE 103-105, PHOENIX, AZ 85051-9581
(602) 863-1862
(602) 293-3591
Mailing address
PO BOX 86537, TUCSON, AZ 85754-6537
(520) 721-1887
(520) 372-7126
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC-155285
AZ
Other
Enumeration date
12/29/2023
Last updated
12/29/2023
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