Healthcare Provider Details

I. General information

NPI: 1801034996
Provider Name (Legal Business Name): ANNETTE THERESA HILL PUCCIA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E CORAL GABLES DR
PHOENIX AZ
85022-3603
US

IV. Provider business mailing address

1 E CORAL GABLES DR
PHOENIX AZ
85022-3603
US

V. Phone/Fax

Practice location:
  • Phone: 602-334-5147
  • Fax: 602-867-0232
Mailing address:
  • Phone: 602-334-5147
  • Fax: 602-867-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-13156
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: