Provider Demographics
NPI:1710602453
Name:DE LA ROSA, JENNIFER ALCALA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ALCALA
Last Name:DE LA ROSA
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 1:6025 FOUNTAINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-4417
Mailing Address - Country:US
Mailing Address - Phone:210-494-3415
Mailing Address - Fax:
Practice Address - Street 1:6025 FOUNTAINWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-4417
Practice Address - Country:US
Practice Address - Phone:210-494-3415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84579101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health