Provider Demographics
NPI:1578986113
Name:SIEMEK, DANUTA MARIA (LCDC)
Entity Type:Individual
Prefix:MRS
First Name:DANUTA
Middle Name:MARIA
Last Name:SIEMEK
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BRYKER DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-6008
Mailing Address - Country:US
Mailing Address - Phone:210-218-5506
Mailing Address - Fax:210-829-0745
Practice Address - Street 1:1777 NE LOOP 410 STE 600
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5218
Practice Address - Country:US
Practice Address - Phone:210-218-5506
Practice Address - Fax:210-829-0745
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11753101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)