Individual
ADALID SIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
3320 S LOOP 256, PALESTINE, TX 75801-6984
(903) 723-6136
(903) 586-4234
Mailing address
1011 COLLEGE AVE, JACKSONVILLE, TX 75766-3307
(903) 586-5507
(903) 586-4234
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
69638
TX
101YP2500X
Professional Counselor
69638
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
69638
LPC LICENSE
TX
Enumeration date
04/11/2016
Last updated
09/19/2018
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