Provider Demographics
NPI:1942678925
Name:LOZANO, DEANDREA (LCDC)
Entity Type:Individual
Prefix:
First Name:DEANDREA
Middle Name:
Last Name:LOZANO
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 1:4021 BACHMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1906
Mailing Address - Country:US
Mailing Address - Phone:214-727-5138
Mailing Address - Fax:
Practice Address - Street 1:303 S JACKSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-3914
Practice Address - Country:US
Practice Address - Phone:972-941-8757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11392101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)