Organization
REPAIRING THE BRIDGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHEILA REED LASAC, TIC (OWNER/THERAPIST)
(520) 701-4575
Entity
Organization
Contact information
Practice address
20740 N MADISON DR, MARICOPA, AZ 85138-8437
(520) 701-4575
Mailing address
20740 N MADISON DR, MARICOPA, AZ 85138-8437
(520) 701-4575
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
09/19/2024
Last updated
12/05/2024
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