Provider Demographics
NPI:1073892030
Name:DIDIER, ANNELLA GRACE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANNELLA
Middle Name:GRACE
Last Name:DIDIER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6226 A COLLEYVILLE BLVD.
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034
Mailing Address - Country:US
Mailing Address - Phone:817-797-4948
Mailing Address - Fax:
Practice Address - Street 1:6226 A COLLEYVILLE BLVD
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6277
Practice Address - Country:US
Practice Address - Phone:817-797-4948
Practice Address - Fax:817-545-1565
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65671101Y00000X, 101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist