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Organization
SOUTHSTAR COUNSELING LLC
Active
Organization
SOUTHSTAR COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL G CORDOVA LCSW (PRESIDENT)
(817) 705-0543
Entity
Organization
Contact information
Practice address
4204 STAGHORN CIR N, FORT WORTH, TX 76137-1121
(817) 705-0543
(817) 386-7623
Mailing address
PO BOX 2512, FORT WORTH, TX 76113-2512
(817) 705-0543
(817) 386-7623
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
51542
TX
Other
Enumeration date
06/18/2012
Last updated
06/18/2012
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