Provider Demographics
NPI:1285270090
Name:DUBCAK, DREW ANNE
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:ANNE
Last Name:DUBCAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4527 N LAMAR BLVD APT 2125
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-2370
Mailing Address - Country:US
Mailing Address - Phone:512-924-5695
Mailing Address - Fax:
Practice Address - Street 1:2520 LONGVIEW ST STE 307
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-4202
Practice Address - Country:US
Practice Address - Phone:512-607-9360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82567101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor