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General NPI Number Information
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NPI Number | 1679374490
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Entity Type | Individual
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Provider Name | MICHAEL GUIA LCDC
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Gender | Male
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 7122 SAN PEDRO AVE STE 114
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City | SAN ANTONIO
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State | TX
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Zip | 78216-6233
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Country | US
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Telephone | 210-432-3700
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Fax | --
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Provider Business Mailing Address
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Address Line | 5534 FREDERICKSBURG RD APT 232
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3598
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Country | US
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Telephone | 210-425-6487
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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 | 16881
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License Number State | TX
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