Healthcare Provider Details

I. General information

NPI: 1578829420
Provider Name (Legal Business Name): DINA ARAGONA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 N 67TH AVE SUITE #400
GLENDALE AZ
85308-3605
US

IV. Provider business mailing address

17100 N 67TH AVE SUITE #400
GLENDALE AZ
85308-3605
US

V. Phone/Fax

Practice location:
  • Phone: 623-938-3323
  • Fax: 602-938-1626
Mailing address:
  • Phone: 623-938-3323
  • Fax: 602-938-1626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-13172
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: