| Doctor Name: | DR. ROBERT DAVID RADOSTA |
| NPI Number: | 1104991165 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | EDD MS |
| License Number: | 11360800 |
| Business Practice Address: | 206 S Rogers St Suite 205 Waxahachie, TX - 751688716 |
| Business Phone Number: | 9728168772 |
| Business Fax Number: | 9726170007 |
| Mailing Address: | Po Box 2716, WAXAHACHIE |
| State: | TX |
| Postal Code: | 751688716 |
| Phone Number: | 9728168772 |
| Fax Number: | 9726170007 |
| NPI Enumeration Date: | 11/22/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 11360800 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |