Individual
SHOCKIE M DERSNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1840 N 95TH AVE STE 146, PHOENIX, AZ 85037-4446
(404) 953-2501
Mailing address
1840 N 95TH AVE STE 146, PHOENIX, AZ 85037-4446
(623) 234-9828
(623) 234-9815
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-18672
AZ
101YP2500X
Professional Counselor
18672
AZ
Other
Enumeration date
01/14/2020
Last updated
07/01/2025
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