Provider Demographics
NPI:1063242949
Name:AVENDANO, EMMA (LCDC)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:AVENDANO
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 W MARTIN ST # MS 49-2
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-0903
Mailing Address - Country:US
Mailing Address - Phone:201-358-5909
Mailing Address - Fax:
Practice Address - Street 1:2121 SW 36TH ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-3360
Practice Address - Country:US
Practice Address - Phone:210-358-5100
Practice Address - Fax:210-358-5128
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16857101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)