Provider Demographics
NPI:1881365518
Name:SANTIAGO, NAKITA JASMINE (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:NAKITA
Middle Name:JASMINE
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66954
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78766-6954
Mailing Address - Country:US
Mailing Address - Phone:512-878-9997
Mailing Address - Fax:
Practice Address - Street 1:1214 ARCADIA AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-3006
Practice Address - Country:US
Practice Address - Phone:512-878-9997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85466101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional