Provider Demographics
NPI:1003560483
Name:MARIETTI, KINDRA RENEE (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KINDRA
Middle Name:RENEE
Last Name:MARIETTI
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:KINDRA
Other - Middle Name:RENEE
Other - Last Name:HEINRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:1150 N LOOP 1604 W STE 108-146
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-4552
Mailing Address - Country:US
Mailing Address - Phone:210-570-6741
Mailing Address - Fax:
Practice Address - Street 1:1150 N LOOP 1604 W STE 108-146
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-4552
Practice Address - Country:US
Practice Address - Phone:210-570-6741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82277101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional