Provider Demographics
NPI:1265097950
Name:COSSEY, CASANDRA (LCDC)
Entity type:Individual
Prefix:MS
First Name:CASANDRA
Middle Name:
Last Name:COSSEY
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 1:700 S. ZARZAMORA STE 209
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207
Mailing Address - Country:US
Mailing Address - Phone:210-822-9493
Mailing Address - Fax:
Practice Address - Street 1:3615 CULEBRA RD.
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228
Practice Address - Country:US
Practice Address - Phone:210-314-6473
Practice Address - Fax:210-314-8676
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16102101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)