Healthcare Provider Details

I. General information

NPI: 1326644758
Provider Name (Legal Business Name): ANASTASIA TURNER LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5228 VILLAGE CREEK DR STE 100
PLANO TX
75093-4430
US

IV. Provider business mailing address

7822 DRIFTWOOD DR
SACHSE TX
75048-6543
US

V. Phone/Fax

Practice location:
  • Phone: 972-913-4738
  • Fax:
Mailing address:
  • Phone: 214-664-2069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15518
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: