Provider Demographics
NPI:1346555026
Name:BOTERO, ADRIANA (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:BOTERO
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12139 PATTON PT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-6215
Mailing Address - Country:US
Mailing Address - Phone:210-815-7880
Mailing Address - Fax:210-731-1385
Practice Address - Street 1:10122 SANDLET TRL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-5886
Practice Address - Country:US
Practice Address - Phone:210-815-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11142101YA0400X
TX80218101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)