Individual
LAINE M DISTEFANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LMFT
Contact information
Practice address
5351 SAMUELL BLVD, DALLAS, TX 75228-6720
(214) 818-2600
Mailing address
8117 PRESTON RD FL 3, DALLAS, TX 75225-6332
(310) 926-2446
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
202250
TX
Other
Enumeration date
05/02/2016
Last updated
05/27/2020
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