Provider Demographics
NPI:1720143241
Name:AXFORD-HOLLINGSHEAD, DARSI J (MA, LPC)
Entity Type:Individual
Prefix:
First Name:DARSI
Middle Name:J
Last Name:AXFORD-HOLLINGSHEAD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 N MILLER RD
Mailing Address - Street 2:#110-23
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3619
Mailing Address - Country:US
Mailing Address - Phone:480-607-1400
Mailing Address - Fax:480-607-1401
Practice Address - Street 1:4300 N MILLER RD
Practice Address - Street 2:#110-23
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3619
Practice Address - Country:US
Practice Address - Phone:480-607-1400
Practice Address - Fax:480-607-1401
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC10757101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ766298Medicaid