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General NPI Number Information
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NPI Number | 1003260571
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Entity Type | Individual
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Provider Name | DESIREE DAWN STANG LPC, CADC III
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Gender | Female
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Dates
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Enumeration Date | 04/20/2016
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 15878 W STATLER ST
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City | SURPRISE
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State | AZ
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Zip | 85374-5726
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Country | US
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Telephone | 503-510-0276
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Fax |
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Provider Business Mailing Address
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Address Line | 15878 W STATLER ST
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City | SURPRISE
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State | AZ
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Zip | 85374-5726
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Country | US
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Telephone | 503-510-0276
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 20-05-25
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C5305
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-23078
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License Number State | AZ
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