Provider Demographics
NPI:1780495432
Name:ROURKE, SUNNY MARIE (MS, LAC)
Entity type:Individual
Prefix:
First Name:SUNNY
Middle Name:MARIE
Last Name:ROURKE
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N BEEBE ST APT 2124
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-7692
Mailing Address - Country:US
Mailing Address - Phone:480-684-0354
Mailing Address - Fax:
Practice Address - Street 1:2680 S. VAL VISTA DR.
Practice Address - Street 2:BUILDING 15, SUITE 185
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295
Practice Address - Country:US
Practice Address - Phone:480-685-0354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-23285101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health