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General NPI Number Information
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NPI Number | 1326496233
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Entity Type | Organization
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Legal Business Name | JOE A. SANTOS, ACSW, LCSW, PLLC
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Dates
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Enumeration Date | 06/01/2016
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Last Update Date | 06/01/2016
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Provider Practice Location Address
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Address Line | 77 CALLE PORTAL SUITE C240
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2986
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Country | US
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Telephone | 520-456-5885
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Fax | 520-452-1447
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Provider Business Mailing Address
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Address Line | 1450 SUNFLOWER WAY
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-5530
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Country | US
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Telephone | 520-456-5885
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Fax | 520-452-1447
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | MR. JOE ANTHONY SANTOS
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Credential | ACSW, LCSW
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Telephone | 520-456-5885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | AZ LCSW 2033
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License Number State | AZ
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