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General NPI Number Information
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NPI Number | 1528626355
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Entity Type | Organization
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Legal Business Name | HOLGUINGRADO CLINICAL SERVICES
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Dates
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Enumeration Date | 06/05/2019
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 12915 JONES MALTSBERGER RD STE 202
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City | SAN ANTONIO
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State | TX
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Zip | 78247-4282
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Country | US
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Telephone | 614-782-1747
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Fax |
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Provider Business Mailing Address
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Address Line | 12915 JONES MALTSBERGER RD STE 202
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City | SAN ANTONIO
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State | TX
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Zip | 78247-4282
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Country | US
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Telephone | 575-494-1324
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MARISA ANDREA HOLGUIN- GRADO
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Credential | LCSW
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Telephone | 575-494-1324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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