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General NPI Number Information
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NPI Number | 1003246802
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Entity Type | Individual
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Provider Name | STAR LYNN GENERA LCDC
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Gender | Female
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 1719 ANALOG DR
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City | RICHARDSON
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State | TX
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Zip | 75081-1944
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Country | US
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Telephone | 214-812-9802
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Fax | 512-900-8325
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Provider Business Mailing Address
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Address Line | 622 ASBURY PARK
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City | GARLAND
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State | TX
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Zip | 75043-5403
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Country | US
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Telephone | 214-881-8118
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 10119
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License Number State | TX
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