Healthcare Provider Details

I. General information

NPI: 1265175863
Provider Name (Legal Business Name): CRISTINA SILVA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4022 GREENWAY RD STE 11 PMB 1148
PHOENIX AZ
85032
US

IV. Provider business mailing address

4022 GREENWAY RD STE 11 PMB 1148
PHOENIX AZ
85032
US

V. Phone/Fax

Practice location:
  • Phone: 480-323-8841
  • Fax:
Mailing address:
  • Phone: 480-323-8841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLAC-18477
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-20948
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: