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General NPI Number Information
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NPI Number | 1962113357
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Entity Type | Organization
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Legal Business Name | DEDICATED DRAGONFLY THERAPY, LLC
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Dates
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Enumeration Date | 12/07/2022
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 10000 N 31ST AVE STE C100-152
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City | PHOENIX
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State | AZ
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Zip | 85051-1397
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Country | US
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Telephone | 602-833-8262
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Fax | 602-883-7847
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Provider Business Mailing Address
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Address Line | 11820 N 43RD DR
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City | GLENDALE
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State | AZ
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Zip | 85304-3001
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Country | US
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Telephone | 602-677-9497
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Fax |
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Authorized Official
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Title or Position | MANAGER/THERAPIST
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Name | SYLVIA ANNE GREEN
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Credential | LCSW
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Telephone | 602-677-9497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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