Provider Demographics
NPI:1780119974
Name:GARZA-GONGORA, ADRIANNA JUDITH (LBSW, LPC)
Entity type:Individual
Prefix:
First Name:ADRIANNA
Middle Name:JUDITH
Last Name:GARZA-GONGORA
Suffix:
Gender:
Credentials:LBSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8526 NICHOLS STONE
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-5069
Mailing Address - Country:US
Mailing Address - Phone:210-835-7566
Mailing Address - Fax:
Practice Address - Street 1:4207 GARDENDALE ST STE 100B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3142
Practice Address - Country:US
Practice Address - Phone:210-570-8535
Practice Address - Fax:210-749-7566
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72785101YP2500X
TX40427104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker