Individual
ANGIE D LICON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3922 WISEMAN BLVD UNIT 4, SAN ANTONIO, TX 78251-1668
(210) 981-6836
Mailing address
314 LAKE CARNEGIE CT, LAREDO, TX 78041-1984
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/13/2025
Last updated
10/13/2025
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