Provider Demographics
NPI:1346584851
Name:PEREIDA, ANNA R (LMSW, LCDC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:R
Last Name:PEREIDA
Suffix:
Gender:F
Credentials:LMSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 W JEFFERSON BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-7860
Mailing Address - Country:US
Mailing Address - Phone:214-521-5191
Mailing Address - Fax:
Practice Address - Street 1:1906 PEABODY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-2821
Practice Address - Country:US
Practice Address - Phone:214-421-7848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57450104100000X
TX12174101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)