Provider Demographics
NPI:1649287558
Name:CAVICCHI, LAURA (LPC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:CAVICCHI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 100823
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-8823
Mailing Address - Country:US
Mailing Address - Phone:210-632-9390
Mailing Address - Fax:210-979-9839
Practice Address - Street 1:8400 BLANCO RD.
Practice Address - Street 2:SUITE # 206
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3055
Practice Address - Country:US
Practice Address - Phone:210-632-9390
Practice Address - Fax:210-979-9839
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18975101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health