Individual
MIRTA I KAPERONIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
30 ACOMA BLVD S, SUITE101-103, LAKE HAVASU CITY, AZ 86403-5957
(928) 680-0604
(928) 680-0605
Mailing address
30 ACOMA BLVD S, SUITE 101-103, LAKE HAVASU CITY, AZ 86403-5957
(928) 680-0604
(928) 680-0605
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LCSW-10019
AZ
101YA0400X
Addiction (Substance Use Disorder) Counselor
LASAC-13100
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LASAC-13100
STATE LICENSE
AZ
01
—
LCSW-10019
STATE LICENSE
AZ
Enumeration date
05/19/2009
Last updated
05/19/2009
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