Provider Demographics
NPI:1689074635
Name:ALCALA, HEATHER DAWN (LCDC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:ALCALA
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 1:701 SANTA ISABEL BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:LAGUNA VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78578-2647
Mailing Address - Country:US
Mailing Address - Phone:361-489-5371
Mailing Address - Fax:956-435-0135
Practice Address - Street 1:701 SANTA ISABEL BLVD STE 4
Practice Address - Street 2:
Practice Address - City:LAGUNA VISTA
Practice Address - State:TX
Practice Address - Zip Code:78578-2647
Practice Address - Country:US
Practice Address - Phone:361-489-5371
Practice Address - Fax:956-435-0135
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12392101YA0400X
TX81631101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX429775601Medicaid
TX81631OtherLPC