Individual
MS. DIANE GENCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
4205 N 7TH AVE, #311, PHOENIX, AZ 85013-3078
(602) 253-8488
(602) 253-8340
Mailing address
4205 N 7TH AVE, #311, PHOENIX, AZ 85013-3078
(602) 253-8488
(602) 253-8340
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC 1330
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
880709
AHCCCS NUMBER
AZ
Enumeration date
02/03/2007
Last updated
08/13/2009
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