Provider Demographics
NPI:1992360713
Name:DANNA-PREMO, PATRICIA (MS, LAC, NCC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:DANNA-PREMO
Suffix:
Gender:F
Credentials:MS, LAC, NCC
Other - Prefix:
Other - First Name:PATTY
Other - Middle Name:
Other - Last Name:DANNA-PREMO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1704 E LOCUST PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-2635
Mailing Address - Country:US
Mailing Address - Phone:540-903-4663
Mailing Address - Fax:
Practice Address - Street 1:1845 S DOBSON RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5662
Practice Address - Country:US
Practice Address - Phone:602-844-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ18139101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program