Organization
WAYNE A. FORMICA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WAYNE ARTHUR FORMICA LPC (LICENSED PROFESSIONAL COUNSELOR)
(480) 677-4804
Entity
Organization
Contact information
Practice address
2055 W FRUIT TREE LN, QUEEN CREEK, AZ 85242-6356
(480) 677-4804
(480) 677-4804
Mailing address
2055 W FRUIT TREE LN, QUEEN CREEK, AZ 85242-6356
(480) 677-4804
(480) 677-4804
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LPC 10413
AZ
Other
Enumeration date
09/18/2007
Last updated
09/18/2007
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