Healthcare Provider Details

I. General information

NPI: 1841961349
Provider Name (Legal Business Name): CONSENTINO CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 W DESERT HILLS DR
GLENDALE AZ
85304-2932
US

IV. Provider business mailing address

4825 W DESERT HILLS DR
GLENDALE AZ
85304-2932
US

V. Phone/Fax

Practice location:
  • Phone: 623-256-0021
  • Fax:
Mailing address:
  • Phone: 623-256-0021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: DELIA CONSENTINO
Title or Position: DIRECTOR
Credential: LISAC
Phone: 623-256-0021