Healthcare Provider Details

I. General information

NPI: 1710175351
Provider Name (Legal Business Name): DIXIE F. CICCARELLI MACE, MAPC, LPC, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 E SHEENA DR
PHOENIX AZ
85032-5809
US

IV. Provider business mailing address

4202 E SHEENA DR
PHOENIX AZ
85032-5809
US

V. Phone/Fax

Practice location:
  • Phone: 602-397-8280
  • Fax: 602-249-8103
Mailing address:
  • Phone: 602-397-8280
  • Fax: 602-249-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC13639
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: