Provider Demographics
NPI:1326496233
Name:JOE A. SANTOS, ACSW, LCSW, PLLC
Entity Type:Organization
Organization Name:JOE A. SANTOS, ACSW, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW, LCSW
Authorized Official - Phone:520-456-5885
Mailing Address - Street 1:1450 SUNFLOWER WAY
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5530
Mailing Address - Country:US
Mailing Address - Phone:520-456-5885
Mailing Address - Fax:520-452-1447
Practice Address - Street 1:77 CALLE PORTAL
Practice Address - Street 2:SUITE C240
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2986
Practice Address - Country:US
Practice Address - Phone:520-456-5885
Practice Address - Fax:520-452-1447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ LCSW 20331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty