| Doctor Name: | MRS. VIRGINIA ARIZONA-FAT |
| NPI Number: | 1467481168 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LISAC,CPS |
| License Number: | LISAC-11471 |
| Business Practice Address: | 337 N. Navajo Drive Page, AZ - 86040 |
| Business Phone Number: | 9286456480 |
| Business Fax Number: | 9286458158 |
| Mailing Address: | P.o. Box 4466, PAGE |
| State: | AZ |
| Postal Code: | 86040 |
| Phone Number: | 9286456840 |
| Fax Number: | 9286458158 |
| NPI Enumeration Date: | 07/03/2006 |
| NPI Last Update Date: | 11/20/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LISAC-11471 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |