Provider Demographics
NPI:1528315926
Name:AVINA, VANESSA (PHD)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:AVINA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CAMINO SANTA MARIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-5433
Mailing Address - Country:US
Mailing Address - Phone:210-436-3135
Mailing Address - Fax:
Practice Address - Street 1:1 CAMINO SANTA MARIA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-5433
Practice Address - Country:US
Practice Address - Phone:210-436-3135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling