Provider Demographics
NPI:1407983323
Name:PICONE, ASHLEY DIANNE (MSW LISAC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DIANNE
Last Name:PICONE
Suffix:
Gender:F
Credentials:MSW LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E FLORENCE BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-4666
Mailing Address - Country:US
Mailing Address - Phone:520-836-4278
Mailing Address - Fax:520-836-1786
Practice Address - Street 1:900 E FLORENCE BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-4666
Practice Address - Country:US
Practice Address - Phone:520-836-4278
Practice Address - Fax:520-836-1786
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10964101YA0400X
AZ242524163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)