Provider Demographics
NPI:1265206932
Name:AGUALLO, FLORENTINA (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:FLORENTINA
Middle Name:
Last Name:AGUALLO
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 S BARTLETT AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-5746
Mailing Address - Country:US
Mailing Address - Phone:956-290-7867
Mailing Address - Fax:
Practice Address - Street 1:9500 TIOGA DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3118
Practice Address - Country:US
Practice Address - Phone:210-616-0828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80004101YP2500X
TX16381101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)