Basic Information
| Provider Information | |||||||||
| NPI: | 1285969725 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STAVROS | ||||||||
| FirstName: | CHI | ||||||||
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| Credential: | LCSW, ACSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8602 W. MORTEN AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6233412041 | ||||||||
| FaxNumber: | 6239771327 | ||||||||
| Practice Location | |||||||||
| Address1: | 1110 E MCDOWELL RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026851940 | ||||||||
| FaxNumber: | 6026851944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2009 | ||||||||
| LastUpdateDate: | 01/14/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW-12659 | AZ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.