Provider Demographics
NPI:1679873780
Name:CANTORNA-IBARRA, DESIREE C (LCPC, CADC-I)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:C
Last Name:CANTORNA-IBARRA
Suffix:
Gender:F
Credentials:LCPC, CADC-I
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:C
Other - Last Name:CANTORNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC, CADC-I
Mailing Address - Street 1:5812 SUTCLIFFE CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-3855
Mailing Address - Country:US
Mailing Address - Phone:702-769-9211
Mailing Address - Fax:
Practice Address - Street 1:5812 SUTCLIFFE CIR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-3855
Practice Address - Country:US
Practice Address - Phone:702-769-9211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01194101YA0400X
NVCP0120101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)