Provider Demographics
NPI:1437692811
Name:SANTIAGO, ROSANNA (NCC, MED, LPC)
Entity Type:Individual
Prefix:
First Name:ROSANNA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:NCC, MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1888 SYLVAN AVE STE F250
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2040
Mailing Address - Country:US
Mailing Address - Phone:972-755-9120
Mailing Address - Fax:
Practice Address - Street 1:1888 SYLVAN AVE STE F250
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2040
Practice Address - Country:US
Practice Address - Phone:972-755-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69871101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional