Individual
MARK CHARLES CONWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
8466 W PEORIA AVE STE 6, PEORIA, AZ 85345-6548
(602) 497-3836
Mailing address
7455 W GREER AVE, PEORIA, AZ 85345-1104
(623) 418-8407
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LAC-17511
AZ
Other
Enumeration date
07/08/2019
Last updated
07/08/2019
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