Individual
JODENE PACKARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
1006 W ELIZABETH RD, FLAGSTAFF, AZ 86001-1204
(928) 607-8495
(928) 213-9740
Mailing address
1006 W ELIZABETH RD, FLAGSTAFF, AZ 86001-1204
(928) 607-8495
(928) 213-9740
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC2508
AZ
101YA0400X
Addiction (Substance Use Disorder) Counselor
LISAC 1466
AZ
Other
Enumeration date
10/10/2006
Last updated
05/15/2013
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