Individual
LENORE GAINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1334 E MILLETT AVE, MESA, AZ 85204-4343
(619) 971-9626
Mailing address
1334 E MILLETT AVE, MESA, AZ 85204-4343
(619) 971-9626
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH7724
AZ
Other
Enumeration date
01/04/2023
Last updated
01/04/2023
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