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Individual
THEREZ DART
Active
Individual
THEREZ DART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, LCDC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
13189
TX
101YP2500X
Professional Counselor
Primary
69550
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
352722801
—
TX
05
—
352722802
—
TX
01
—
838LQB
BCBS
TX
Enumeration date
12/14/2015
Last updated
11/04/2022
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