Individual
LACRESHIA CASAUNDRA WITCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2802 N 37TH AVE, PHOENIX, AZ 85009-1338
(602) 828-5725
Mailing address
2802 N 37TH AVE, PHOENIX, AZ 85009-1338
(602) 828-5725
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
OTC8341
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21213
—
AZ
Enumeration date
10/11/2017
Last updated
06/11/2019
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