Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC-10737 | AZ |
NPI | 1003071549 |
---|---|
Provider Name | Mrs. Diana Iris Sanchez-Kasicki |
First Address | Buckeye, AZ 85326-6280 |
Second Address | Goodyear, AZ 85338-1256 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2008 |
Last Update Date | 26/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
742562293 | (05) | AZ |
864555 | (05) | AZ |