Provider Demographics
NPI:1861539769
Name:MAGANA, VICKY LAURIE (LCSW)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:LAURIE
Last Name:MAGANA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3765 S ALAMEDA ST STE 319
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1672
Mailing Address - Country:US
Mailing Address - Phone:361-232-6409
Mailing Address - Fax:888-680-2764
Practice Address - Street 1:3765 S ALAMEDA ST STE 319
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1672
Practice Address - Country:US
Practice Address - Phone:361-232-6409
Practice Address - Fax:888-680-2764
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX404211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166816202Medicaid
TX166816201Medicaid