Individual
MR. CARL GARETH CORDOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
4204 STAGHORN CIR N, FORT WORTH, TX 76137-1121
(817) 846-3497
Mailing address
PO BOX 2512, FORT WORTH, TX 76113-2512
(817) 846-3497
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
51542
TX
Other
Enumeration date
10/12/2011
Last updated
04/05/2012
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