Individual
LISA C. MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCDC
Contact information
Practice address
5808 BALCONES DR, 201, AUSTIN, TX 78731-4255
(512) 804-3650
(512) 476-0217
Mailing address
2010 ROCKLAND DR, AUSTIN, TX 78748-3066
(512) 809-6390
(512) 454-5039
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11182
TX
Other
Enumeration date
10/26/2010
Last updated
11/05/2012
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