Individual
SAMANTHA HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2622 S 102ND LN, TOLLESON, AZ 85353-5678
(480) 442-7635
Mailing address
PO BOX 304, TOLLESON, AZ 85353-0304
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
18885
AZ
Other
Enumeration date
06/28/2020
Last updated
12/30/2020
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