Individual
COLLEEN LOUISE FOOTE-DERANGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LISAC, SEP
Contact information
Practice address
16724 WILLOW AVE., YARNELL, AZ 85362
(928) 231-2006
Mailing address
PO BOX 564, YARNELL, AZ 85362-0564
(928) 231-2006
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
LISAC-11512
AZ
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
02/19/2016
Last updated
02/19/2016
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