Provider Demographics
NPI:1013797521
Name:MACIAS-SARABIA, VICTOR ALFONSO (LPC)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:ALFONSO
Last Name:MACIAS-SARABIA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:VICTOR
Other - Middle Name:
Other - Last Name:MACIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1952 E LEISURE LN
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-6704
Mailing Address - Country:US
Mailing Address - Phone:702-772-5302
Mailing Address - Fax:
Practice Address - Street 1:4848 E CACTUS RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4163
Practice Address - Country:US
Practice Address - Phone:480-443-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-21092101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional