Healthcare Provider Details

I. General information

NPI: 1962021436
Provider Name (Legal Business Name): CAROLINA MEJIA SANTANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12843 HUNTSMAN LAKE DR
SAN ANTONIO TX
78249-4476
US

IV. Provider business mailing address

12843 HUNTSMAN LAKE DR
SAN ANTONIO TX
78249-4476
US

V. Phone/Fax

Practice location:
  • Phone: 678-522-7750
  • Fax:
Mailing address:
  • Phone: 678-522-7750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: