Basic Information
| Provider Information | |||||||||
| NPI: | 1811485584 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RONN | ||||||||
| FirstName: | DAVINA | ||||||||
| MiddleName: | ELENA | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 CALLE PORTAL STE 100 | ||||||||
| Address2: | |||||||||
| City: | SIERRA VISTA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856352900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205158673 | ||||||||
| FaxNumber: | 5205158663 | ||||||||
| Practice Location | |||||||||
| Address1: | 108 ARIZONA ST | ||||||||
| Address2: | |||||||||
| City: | BISBEE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856031804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204323309 | ||||||||
| FaxNumber: | 5204323717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2018 | ||||||||
| LastUpdateDate: | 04/27/2018 | ||||||||
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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-17017 | AZ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.