Provider Demographics
NPI:1942492269
Name:MALDONADO, SANTANA (LPC-S, LCDC, LCCA)
Entity Type:Individual
Prefix:
First Name:SANTANA
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:LPC-S, LCDC, LCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10726 GREEN TRAIL ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223
Mailing Address - Country:US
Mailing Address - Phone:210-286-5423
Mailing Address - Fax:
Practice Address - Street 1:10726 GREEN TRAIL ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223
Practice Address - Country:US
Practice Address - Phone:210-628-6542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20062101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178405001Medicaid