Provider Demographics
NPI:1417542846
Name:ATIDEPE, ROSINE A (MA, LPC)
Entity Type:Individual
Prefix:MISS
First Name:ROSINE
Middle Name:A
Last Name:ATIDEPE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20114 NEW SUNRISE TRL
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-7371
Mailing Address - Country:US
Mailing Address - Phone:832-397-9604
Mailing Address - Fax:
Practice Address - Street 1:20114 NEW SUNRISE TRL
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-7371
Practice Address - Country:US
Practice Address - Phone:832-397-9604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82254101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional