Provider Demographics
NPI:1508198649
Name:DEVINE, ADRIENNE RAE (LCSW)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:RAE
Last Name:DEVINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 VALONA LOOP
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3893
Mailing Address - Country:US
Mailing Address - Phone:512-789-3627
Mailing Address - Fax:512-642-4207
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD
Practice Address - Street 2:SUITE F1
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8661
Practice Address - Country:US
Practice Address - Phone:512-789-3627
Practice Address - Fax:512-642-4207
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-30
Last Update Date:2010-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX415321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical