Provider Demographics
NPI:1679865299
Name:BIRDSONG, ADRIANA (LCSW)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:BIRDSONG
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 1:14269 HUNTER CRK
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-5146
Mailing Address - Country:US
Mailing Address - Phone:915-228-4855
Mailing Address - Fax:
Practice Address - Street 1:14269 HUNTER CRK
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-5146
Practice Address - Country:US
Practice Address - Phone:915-228-4855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX401991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2860223Medicaid