Provider Demographics
NPI:1356764906
Name:MAIDA, GENEVIEVE (LCDC)
Entity type:Individual
Prefix:MS
First Name:GENEVIEVE
Middle Name:
Last Name:MAIDA
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 1:722 PIN OAK RD STE 220
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6328
Mailing Address - Country:US
Mailing Address - Phone:281-371-0360
Mailing Address - Fax:281-371-2080
Practice Address - Street 1:722 PIN OAK RD STE 220
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6328
Practice Address - Country:US
Practice Address - Phone:281-371-0360
Practice Address - Fax:281-371-2080
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11197101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX220372101Medicaid