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General NPI Number Information
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NPI Number | 1417470287
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Entity Type | Organization
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Legal Business Name | DYNAMIC COUNSELING AND COACHING SOLUTIONS, LLC
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Dates
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Enumeration Date | 07/24/2017
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Last Update Date | 03/01/2019
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Provider Practice Location Address
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Address Line | 13201 N 35TH AVE STE 5B
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City | PHOENIX
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State | AZ
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Zip | 85029-1231
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Country | US
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Telephone | 602-777-1268
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Fax | 866-251-5468
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Provider Business Mailing Address
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Address Line | 24654 N LAKE PLEASANT PKWY # 103-328
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City | PEORIA
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State | AZ
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Zip | 85383-1359
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Country | US
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Telephone | 602-777-1268
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ERICA SHUMATE SIMS
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Credential | LPC
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Telephone | 602-777-1268
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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 | LPC-15992
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-15992
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License Number State | AZ
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