Healthcare Provider Details

I. General information

NPI: 1588322655
Provider Name (Legal Business Name): LEADING LADIES TO LIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 E BROADWAY RD STE 200
TEMPE AZ
85282-1377
US

IV. Provider business mailing address

64 E BROADWAY RD STE 200
TEMPE AZ
85282-1377
US

V. Phone/Fax

Practice location:
  • Phone: 480-372-4365
  • Fax:
Mailing address:
  • Phone: 480-372-4365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DARNIECIA TUCKER
Title or Position: CEO
Credential:
Phone: 520-261-8559