Healthcare Provider Details

I. General information

NPI: 1063348530
Provider Name (Legal Business Name): SOW RESTORATION & TRANSFORMATION COMMUNITY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7931 E PECOS RD STE 211
MESA AZ
85212-6511
US

IV. Provider business mailing address

7931 E PECOS RD STE 211
MESA AZ
85212-6511
US

V. Phone/Fax

Practice location:
  • Phone: 480-442-6273
  • Fax:
Mailing address:
  • Phone: 480-442-6273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHANEN DUNAGAN
Title or Position: OWNER / CEO
Credential:
Phone: 480-939-1985