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General NPI Number Information
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NPI Number | 1740487594
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Entity Type | Individual
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Provider Name | GEOVANA COLOSIO LISAC
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Gender | Female
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1020 S 4TH AVE SUITE C
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City | YUMA
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State | AZ
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Zip | 85364-3859
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Country | US
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Telephone | 928-343-9825
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Fax |
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Provider Business Mailing Address
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Address Line | 1842 S 17TH AVE
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City | YUMA
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State | AZ
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Zip | 85364-5354
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Country | US
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Telephone | 928-782-6455
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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 | LISAC-11460
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License Number State | AZ
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