Healthcare Provider Details

I. General information

NPI: 1801763370
Provider Name (Legal Business Name): LISA G AGUILAR LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 W COMMERCE ST
SAN ANTONIO TX
78207-3611
US

IV. Provider business mailing address

103 DEER LN
NEW BRAUNFELS TX
78130-8908
US

V. Phone/Fax

Practice location:
  • Phone: 210-434-0531
  • Fax:
Mailing address:
  • Phone: 830-475-2459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17538
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: