Healthcare Provider Details

I. General information

NPI: 1780033787
Provider Name (Legal Business Name): HEALING WOUNDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 N HAYDEN RD STE A-108
SCOTTSDALE AZ
85258-2458
US

IV. Provider business mailing address

8300 N HAYDEN RD STE A-108
SCOTTSDALE AZ
85258-2458
US

V. Phone/Fax

Practice location:
  • Phone: 210-355-6207
  • Fax: 480-467-0248
Mailing address:
  • Phone: 210-355-6207
  • Fax: 480-467-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberAZ 4696
License Number StateAZ

VIII. Authorized Official

Name: SONJA LOUISE RACITI
Title or Position: OWNER
Credential: D.O
Phone: 210-355-6207