Healthcare Provider Details

I. General information

NPI: 1093081804
Provider Name (Legal Business Name): MARGARET HLAVINKA LPC INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAGGIE HLAVINKA

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 BLANCO RD SUITE 501
SAN ANTONIO TX
78216-4936
US

IV. Provider business mailing address

PO BOX 460429
SAN ANTONIO TX
78246-0429
US

V. Phone/Fax

Practice location:
  • Phone: 210-878-9623
  • Fax: 888-823-3497
Mailing address:
  • Phone: 210-878-9623
  • Fax: 888-823-3497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number65535
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: