Individual
MR. SERGIO XAVIER SANTOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA, LISAC
Contact information
Practice address
5501 N 19TH AVE STE 103, PHOENIX, AZ 85015
(602) 589-0500
(602) 314-4552
Mailing address
5501 N 19TH AVE STE 103, PHOENIX, AZ 85015-2451
(602) 589-0500
(602) 314-4552
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC-1627
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
600241392
MAGELLAN
AZ
Enumeration date
09/18/2008
Last updated
01/03/2019
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