Provider Demographics
NPI:1972666998
Name:CRADDOCK, ADRIANA L (LPA, LPC, LBSW)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:L
Last Name:CRADDOCK
Suffix:
Gender:F
Credentials:LPA, LPC, LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 GUSTAVUS ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-2424
Mailing Address - Country:US
Mailing Address - Phone:956-729-1991
Mailing Address - Fax:956-724-4081
Practice Address - Street 1:2315 E SAUNDERS ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5434
Practice Address - Country:US
Practice Address - Phone:956-729-1991
Practice Address - Fax:956-724-4081
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16993101YP2500X
TX37072171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1435026Medicaid