Provider Demographics
NPI:1114689940
Name:RANGEL, GINA MARIE (LCDCI)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:RANGEL
Suffix:
Gender:F
Credentials:LCDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 CRESWELL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220-2601
Mailing Address - Country:US
Mailing Address - Phone:210-542-5540
Mailing Address - Fax:
Practice Address - Street 1:519 E QUINCY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1632
Practice Address - Country:US
Practice Address - Phone:210-299-1614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51211101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)