Provider Demographics
NPI:1467858597
Name:BECKER, CAROLINE (LISAC)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12317 E NORTH LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5240
Mailing Address - Country:US
Mailing Address - Phone:602-677-3567
Mailing Address - Fax:480-699-5430
Practice Address - Street 1:3200 N HAYDEN RD
Practice Address - Street 2:#170
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6652
Practice Address - Country:US
Practice Address - Phone:602-677-3567
Practice Address - Fax:480-699-5430
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10983101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)