Provider Demographics
NPI:1972724482
Name:ZACARIAS, AGNES MARIE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:AGNES
Middle Name:MARIE
Last Name:ZACARIAS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 MEDICAL DR
Mailing Address - Street 2:APT. # 712
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5388
Mailing Address - Country:US
Mailing Address - Phone:210-264-5464
Mailing Address - Fax:
Practice Address - Street 1:8550 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1803
Practice Address - Country:US
Practice Address - Phone:210-568-8542
Practice Address - Fax:210-568-0624
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18094101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional