Healthcare Provider Details

I. General information

NPI: 1366389579
Provider Name (Legal Business Name): AGAPE COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17505 N 79TH AVE STE 311F
GLENDALE AZ
85308-8730
US

IV. Provider business mailing address

27806 N 65TH LN
PHOENIX AZ
85083-7580
US

V. Phone/Fax

Practice location:
  • Phone: 623-850-5404
  • Fax:
Mailing address:
  • Phone: 623-703-0979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. DARCY DUDLESTON BRACAMONTE
Title or Position: OWNER
Credential: MA
Phone: 623-850-5404