Provider Demographics
NPI:1639616147
Name:POREMBSKI, GINNIE ELIZABETH (LPC)
Entity Type:Individual
Prefix:
First Name:GINNIE
Middle Name:ELIZABETH
Last Name:POREMBSKI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 LBJ FWY STE 900
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3443
Mailing Address - Country:US
Mailing Address - Phone:214-458-5046
Mailing Address - Fax:
Practice Address - Street 1:9330 LBJ FWY STE 900
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3443
Practice Address - Country:US
Practice Address - Phone:214-458-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-22
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62332101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional