Provider Demographics
NPI:1811312226
Name:GINESTRA, DAWN
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:GINESTRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 MEDICAL PKWY
Mailing Address - Street 2:SUITE 255
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-4026
Mailing Address - Country:US
Mailing Address - Phone:512-745-4306
Mailing Address - Fax:
Practice Address - Street 1:3810 MEDICAL PKWY
Practice Address - Street 2:SUITE 255
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4026
Practice Address - Country:US
Practice Address - Phone:512-745-4306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10816101YA0400X
TX65041101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)