Basic Information
| Provider Information | |||||||||
| NPI: | 1346555026 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOTERO | ||||||||
| FirstName: | ADRIANA | ||||||||
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| Credential: | LPC, LCDC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12139 PATTON PT | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782546215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2108157880 | ||||||||
| FaxNumber: | 2107311385 | ||||||||
| Practice Location | |||||||||
| Address1: | 10122 SANDLET TRL | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782545886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2108157880 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2010 | ||||||||
| LastUpdateDate: | 02/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 11142 | TX | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 80218 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.