Provider Demographics
NPI:1841383791
Name:WARREN, DOROTHY R (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:R
Last Name:WARREN
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:PO BOX 701366
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78270-1366
Mailing Address - Country:US
Mailing Address - Phone:210-287-6386
Mailing Address - Fax:
Practice Address - Street 1:117 SOUTHBRIDGE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6229
Practice Address - Country:US
Practice Address - Phone:210-287-6386
Practice Address - Fax:210-525-9515
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19949101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182675201Medicaid