Provider Demographics
NPI:1730976358
Name:MSAFIRI, EDITH WAKASA (LAAC)
Entity type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:WAKASA
Last Name:MSAFIRI
Suffix:
Gender:
Credentials:LAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 W GARY WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-1517
Mailing Address - Country:US
Mailing Address - Phone:602-668-2783
Mailing Address - Fax:
Practice Address - Street 1:3850 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4402
Practice Address - Country:US
Practice Address - Phone:602-668-2783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAAC-08039T101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty