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General NPI Number Information
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NPI Number | 1245695410
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Entity Type | Organization
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Legal Business Name | C4A PLLC
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Dates
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Enumeration Date | 12/15/2015
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | 801 E CAMPBELL RD STE 510
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City | RICHARDSON
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State | TX
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Zip | 75081-6702
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Country | US
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Telephone | 972-744-9990
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Fax | 972-744-9995
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Provider Business Mailing Address
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Address Line | 801 E CAMPBELL RD STE 510
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City | RICHARDSON
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State | TX
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Zip | 75081-6702
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MARGRET LOUISE WARD
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Credential | LCSW
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Telephone | 972-744-9990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 26893
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License Number State | TX
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