Individual
BERNICE ANN MACIAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC, LISAC
Contact information
Practice address
18001 N 79TH AVE, SUITE B45, GLENDALE, AZ 85308-8388
(623) 221-3466
(623) 334-6724
Mailing address
PO BOX 546, PEORIA, AZ 85380-0546
(623) 221-3466
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LISAC-10993
AZ
101YP2500X
Professional Counselor
Primary
LPC-12397
AZ
Other
Enumeration date
02/15/2008
Last updated
04/06/2009
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