Provider Demographics
NPI:1023257839
Name:PIERCE, JOSEPHINE K (LISAC)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:K
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 N CENTRAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2902
Mailing Address - Country:US
Mailing Address - Phone:602-302-7715
Mailing Address - Fax:602-302-7925
Practice Address - Street 1:4425 W OLIVE AVE
Practice Address - Street 2:# 200 & 140
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-3843
Practice Address - Country:US
Practice Address - Phone:602-685-6000
Practice Address - Fax:602-930-0358
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC10215101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ10215OtherLISAC