Provider Demographics
NPI:1336916311
Name:PAXTON, GINA (LMSW)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:PAXTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:PAXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 DEZARAE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5840
Mailing Address - Country:US
Mailing Address - Phone:210-529-8410
Mailing Address - Fax:
Practice Address - Street 1:1401 DEZARAE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5840
Practice Address - Country:US
Practice Address - Phone:210-529-8410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1081731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical