Healthcare Provider Details

I. General information

NPI: 1205999430
Provider Name (Legal Business Name): ARCADIA COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 N. 44TH ST. #120
PHOENIX AZ
85018
US

IV. Provider business mailing address

3610 N. 44TH ST #120
PHOENIX AZ
85018
US

V. Phone/Fax

Practice location:
  • Phone: 602-218-6901
  • Fax: 602-218-6901
Mailing address:
  • Phone: 602-218-6901
  • Fax: 602-218-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11071
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11676
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GREGORY SCOTT GIBSON
Title or Position: OWNER/PARTNER
Credential: MA, LPC
Phone: 602-218-6901