Doctor Name: | STAR LYNN GENERA |
NPI Number: | 1003246802 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCDC |
License Number: | 10119 |
Business Practice Address: | 1719 Analog Dr Richardson, TX - 750811944 |
Business Phone Number: | 2148129802 |
Business Fax Number: | 5129008325 |
Mailing Address: | 622 Asbury Park, GARLAND |
State: | TX |
Postal Code: | 750435403 |
Phone Number: | 2148818118 |
Fax Number: | |
NPI Enumeration Date: | 11/15/2013 |
NPI Last Update Date: | 11/15/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 10119 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |