Provider Demographics
NPI:1760530489
Name:PROFOTA, AVA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AVA
Middle Name:
Last Name:PROFOTA
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 1:2000 NORTH LOOP W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-8124
Mailing Address - Country:US
Mailing Address - Phone:713-868-2908
Mailing Address - Fax:713-864-2395
Practice Address - Street 1:2000 NORTH LOOP W
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-8124
Practice Address - Country:US
Practice Address - Phone:713-868-2908
Practice Address - Fax:713-864-2395
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX360931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical