Provider Demographics
NPI:1619154937
Name:UPAH, DIONNE D (LAC)
Entity Type:Individual
Prefix:MS
First Name:DIONNE
Middle Name:D
Last Name:UPAH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 W OSBORN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019-4006
Mailing Address - Country:US
Mailing Address - Phone:602-565-9963
Mailing Address - Fax:602-269-5380
Practice Address - Street 1:3640 W OSBORN RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-4006
Practice Address - Country:US
Practice Address - Phone:602-565-9963
Practice Address - Fax:602-269-5300
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-12782101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor