Provider Demographics
NPI:1376545830
Name:RAFAILEDES, CONSTANCE MARIE (MA, LPC, RPT)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:MARIE
Last Name:RAFAILEDES
Suffix:
Gender:F
Credentials:MA, LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 GRANBURY ST
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-5752
Mailing Address - Country:US
Mailing Address - Phone:817-645-3328
Mailing Address - Fax:817-558-3203
Practice Address - Street 1:1011 GRANBURY ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-5752
Practice Address - Country:US
Practice Address - Phone:817-645-3328
Practice Address - Fax:817-558-3203
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10051101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health