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Individual

MRS. DARCY DUDLESTON BRACAMONTE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LIAC, LPC

Contact information

Practice address
17505 N. 79TH AVE, 302A, GLENDALE, AZ 85308
(623) 850-5404
Mailing address
17505 N 79TH AVE STE 311F, GLENDALE, AZ 85308-8730
(623) 850-5404

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LIAC-11520
AZ
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC-11520
AZ
101YM0800X
Mental Health Counselor
LAC-11168
AZ
101YM0800X
Mental Health Counselor
Primary
LPC-24561
AZ

Other

Enumeration date
02/08/2016
Last updated
03/24/2026
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