Individual
LISA JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LADAC
Contact information
Practice address
HWY 160 163 BLDING KA 2010, KAYENTA, AZ 86033-0368
(928) 697-4185
(928) 697-4189
Mailing address
PO BOX 368, KAYENTA, AZ 86033-0368
(928) 697-4185
(928) 697-4189
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
4575
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060012
—
AZ
Enumeration date
08/28/2007
Last updated
08/28/2007
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