Individual
KELLY VICKREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3042 W QUEEN CREEK RD, CHANDLER, AZ 85248-2815
(520) 796-2600
(520) 796-2649
Mailing address
PO BOX 923, CHANDLER, AZ 85244-0923
(602) 370-1742
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC-11614
AZ
Other
Enumeration date
09/04/2014
Last updated
10/25/2024
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