Individual
TINA L BOOTHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADAC
Contact information
Practice address
2200 BERGQUIST DR, LACKLAND A F B, TX 78236-9907
(210) 292-7725
Mailing address
2200 BERGQUIST DR, LACKLAND A F B, TX 78236-9907
(210) 292-7725
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1090
ICRC
—
Enumeration date
09/14/2009
Last updated
09/14/2009
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