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General NPI Number Information
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NPI Number | 1891209961
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Entity Type | Organization
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Legal Business Name | DANTIA WELLNESS LLC
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Dates
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Enumeration Date | 11/27/2017
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 34406 N 27TH DR STE 140
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City | PHOENIX
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State | AZ
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Zip | 85085-6079
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Country | US
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Telephone | 602-859-5550
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 43527
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City | PHOENIX
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State | AZ
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Zip | 85080-3527
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Country | US
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Telephone | 602-859-5550
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ALEXANDRA J HOUSE
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Credential | MA, LPC
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Telephone | 602-859-5550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT-15223
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-16029
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License Number State |
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