Individual
CORAL FANTASIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
3000 POLAR LN STE 101, CEDAR PARK, TX 78613-3065
(844) 824-8775
Mailing address
3000 POLAR LN STE 101, CEDAR PARK, TX 78613-3065
(844) 824-8775
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
113615
TX
1041C0700X
Clinical Social Worker
IC-1932
NV
Other
Enumeration date
05/05/2022
Last updated
11/11/2024
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