Individual
LORENE JA'QUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISAC
Contact information
Practice address
4825 N SABINO CANYON RD, TUCSON, AZ 85750-6427
(520) 495-6206
(520) 884-0383
Mailing address
4825 N SABINO CANYON RD, TUCSON, AZ 85750-6427
(520) 495-6206
(520) 884-0383
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC-10072
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LISAC-10072
AZ BOARD OF BEHAVIORAL HEALTH EXAMINERS LICENSE LISAC
AZ
Enumeration date
02/25/2020
Last updated
02/25/2020
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