| None | |
|
5251 W Campbell Ave Ste 204 Phoenix AZ 85031-1719 | |
| (480) 258-8703 | |
| Not Available |
| Full Name | None |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 5251 W Campbell Ave Ste 204, Phoenix, Arizona |
| Authorized Official Name and Position | Drocelle Meda Wilson (CEO) |
| Authorized Official Contact | 4802588703 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| None 5251 W Campbell Ave Ste 204 Phoenix AZ 85031-1719 Ph: (480) 258-8703 | None 5251 W Campbell Ave Ste 204 Phoenix AZ 85031-1719 Ph: (480) 258-8703 |
| NPI Number | 1033971742 |
|---|---|
| Provider Enumeration Date | 01/29/2024 |
| Last Update Date | 04/04/2024 |
| Certification Date | 04/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033971742 | NPI | - | NPPES |
| OTC13126 | Medicaid | AZ |
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