Provider Demographics
NPI:1114377181
Name:MARCON, MARIA LETICIA (LPC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LETICIA
Last Name:MARCON
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 1:4922 CORIAN WELL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5905
Mailing Address - Country:US
Mailing Address - Phone:407-617-1864
Mailing Address - Fax:
Practice Address - Street 1:1380 PANTHEON WAY
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2288
Practice Address - Country:US
Practice Address - Phone:210-317-8520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71815101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional