Healthcare Provider Details

I. General information

NPI: 1104540327
Provider Name (Legal Business Name): ASAVA GENIECE DUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4235 W SAN JUAN AVE
PHOENIX AZ
85019-2009
US

IV. Provider business mailing address

500 N ESTRELLA PKWY # B2-206
GOODYEAR AZ
85338-4135
US

V. Phone/Fax

Practice location:
  • Phone: 833-258-5683
  • Fax:
Mailing address:
  • Phone: 833-258-5683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: