Healthcare Provider Details

I. General information

NPI: 1255734075
Provider Name (Legal Business Name): CATHERINE A PADDACK LISAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE A HAVILAND

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 E MCDOWELL RD
PHOENIX AZ
85008-7735
US

IV. Provider business mailing address

3003 N CENTRAL AVE STE 200
PHOENIX AZ
85012-2914
US

V. Phone/Fax

Practice location:
  • Phone: 602-685-6000
  • Fax: 602-275-1355
Mailing address:
  • Phone: 602-685-6000
  • Fax: 602-265-6973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC-10421
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: