Provider Demographics
NPI:1093016107
Name:CANTU, DAVID ALEXANDER (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALEXANDER
Last Name:CANTU
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 FREDERICKSBURG RD
Mailing Address - Street 2:STE. B
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3661
Mailing Address - Country:US
Mailing Address - Phone:210-977-0261
Mailing Address - Fax:210-977-0263
Practice Address - Street 1:4811 FREDERICKSBURG RD
Practice Address - Street 2:STE. B
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3661
Practice Address - Country:US
Practice Address - Phone:210-977-0261
Practice Address - Fax:210-977-0263
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54534104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2-$$$$$$$$$-6-001OtherDARS