Individual
ROBERT WILLIAM DAUGHENBAUGH JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISAC
Contact information
Practice address
3420 E SHEA BLVD, PHOENIX, AZ 85028-3345
(602) 730-5206
Mailing address
3914 E CORTEZ ST, PHOENIX, AZ 85028-2122
(859) 319-7030
(602) 252-0830
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
155280
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
155280
LICENSED INDEPENDENT SUBSTANCE ABUSE COUNSELOR
AZ
Enumeration date
10/02/2020
Last updated
07/16/2024
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