Provider Demographics
NPI:1235446063
Name:WARNER, CHAD RUSSELL (LCDC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:RUSSELL
Last Name:WARNER
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 MEDICAL DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5657
Mailing Address - Country:US
Mailing Address - Phone:210-280-0262
Mailing Address - Fax:210-615-1122
Practice Address - Street 1:4115 MEDICAL DR
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5657
Practice Address - Country:US
Practice Address - Phone:210-280-0262
Practice Address - Fax:210-615-1122
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11175101YA0400X
TX201527106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist