| NPI | 1902092422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE ARTHUR FORMICA Licensed Professional Counselor 480-677-4804 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: AZ LPC 10413) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2007-09-18 |