Provider Demographics
NPI:1164712311
Name:RIVERA SLOAN, WANDA (LPC)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:RIVERA SLOAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:
Other - Last Name:RIVERA PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18834 STONE OAK PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4177
Mailing Address - Country:US
Mailing Address - Phone:210-454-2133
Mailing Address - Fax:
Practice Address - Street 1:18834 STONE OAK PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4113
Practice Address - Country:US
Practice Address - Phone:210-454-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64922101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional