Provider Demographics
NPI:1043989478
Name:DIGNITY LIFE COUNSELING LLC
Entity type:Organization
Organization Name:DIGNITY LIFE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:623-734-2224
Mailing Address - Street 1:21397 W TERRI LEE DR
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-2457
Mailing Address - Country:US
Mailing Address - Phone:623-734-2224
Mailing Address - Fax:
Practice Address - Street 1:21397 W TERRI LEE DR
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-2457
Practice Address - Country:US
Practice Address - Phone:623-734-2224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty