Individual
LEANN VICTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISAC
Contact information
Practice address
5 SAN CARLOS AVENUE, SAN CARLOS, AZ 85550-9999
(928) 475-4875
(928) 475-3453
Mailing address
5 SAN CARLOS AVENUE, SAN CARLOS, AZ 85550-9999
(928) 475-4875
(928) 475-3453
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
10845
AZ
Other
Enumeration date
09/18/2013
Last updated
09/18/2013
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