Individual
MS. MARCIA DIANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LISAC
Contact information
Practice address
1801 S. JENTILLY LANE, SUITE B-16, TEMPE, AZ 85281
(480) 540-1752
Mailing address
554 N ASPEN DR, CHANDLER, AZ 85226-2718
(480) 540-1752
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LISAC-11482
AZ
101YM0800X
Mental Health Counselor
Primary
LPC-12786
AZ
Other
Enumeration date
06/15/2010
Last updated
05/31/2013
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