| Deep Dive Individual And Family Counseling Services Pllc | |
|
7400 Blanco Rd Ste 250 San Antonio TX 78216-4368 | |
| (210) 643-4058 | |
| (866) 544-0326 |
| Full Name | Deep Dive Individual And Family Counseling Services Pllc |
|---|---|
| Speciality | Counselor |
| Location | 7400 Blanco Rd Ste 250, San Antonio, Texas |
| Authorized Official Name and Position | Shenna Dominique Fisher (LCSW/OWNER) |
| Authorized Official Contact | 2106434058 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Deep Dive Individual And Family Counseling Services Pllc 11300 Expo Blvd Apt 1010 San Antonio TX 78230-1333 Ph: (210) 643-4058 | Deep Dive Individual And Family Counseling Services Pllc 7400 Blanco Rd Ste 250 San Antonio TX 78216-4368 Ph: (210) 643-4058 |
| NPI Number | 1003445818 |
|---|---|
| Provider Enumeration Date | 04/03/2020 |
| Last Update Date | 02/11/2023 |
| Certification Date | 02/11/2023 |
| Medicare PECOS PAC ID | 3072939719 |
|---|---|
| Medicare Enrollment ID | O20200812002573 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003445818 | NPI | - | NPPES |
| 1F6319 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Shenna D Fisher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295227304 PECOS PAC ID: 9335498526 Enrollment ID: I20180821003586 |
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