Provider Demographics
NPI:1639563760
Name:KRATOCHVIL, CAROL CARROLL (LCDC)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:CARROLL
Last Name:KRATOCHVIL
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 1:300 E MULBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3023
Mailing Address - Country:US
Mailing Address - Phone:210-735-3822
Mailing Address - Fax:210-735-1908
Practice Address - Street 1:300 E MULBERRY AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3023
Practice Address - Country:US
Practice Address - Phone:210-735-3822
Practice Address - Fax:210-735-1908
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10727101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)