Healthcare Provider Details

I. General information

NPI: 1063365724
Provider Name (Legal Business Name): MERCEDES HERNANDEZ LAAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3639 W LINCOLN ST
PHOENIX AZ
85009-5516
US

IV. Provider business mailing address

2610 W ESTES WAY
PHOENIX AZ
85041-9535
US

V. Phone/Fax

Practice location:
  • Phone: 602-233-9747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAAC-15287
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: