Individual
MS. TINA M LAPORTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, LADC, MFT
Contact information
Practice address
3851 ROGER BROOKE DR, MCHE-QD, CREDENTIALING, FORT SAM HOUSTON, TX 78234-4501
(210) 916-1143
Mailing address
3851 ROGER BROOK DRIVE, MCHE-QD, CREDENTIALING, FORT SAM HOUSTON, SAN ANTONIO, TX 78234
(860) 804-4000
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
CT
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11585154
CAQH
CT
Enumeration date
04/17/2007
Last updated
02/17/2010
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