Individual
LACEY CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1580 N KOLB RD STE 206, TUCSON, AZ 85715-4933
(520) 214-8650
Mailing address
9750 N ORACLE RD APT 14107, TUCSON, AZ 85704-7683
(623) 217-0882
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-19410
AZ
Other
Enumeration date
05/12/2021
Last updated
05/12/2021
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