Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 10119 | TX |
NPI | 1003246802 |
---|---|
Provider Name | Star Lynn Genera |
First Address | Garland, TX 75043-5403 |
Second Address | Richardson, TX 75081-1944 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2013 |
Last Update Date | 15/11/2013 |