Provider Demographics
NPI:1609671155
Name:DE LA FUENTE, ANGELINA CHRISTINA MARIA (LPC-A)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:CHRISTINA MARIA
Last Name:DE LA FUENTE
Suffix:
Gender:
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12103 SCHROEDER RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3648
Mailing Address - Country:US
Mailing Address - Phone:956-778-3769
Mailing Address - Fax:
Practice Address - Street 1:554 W RALPH HALL PKWY
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6644
Practice Address - Country:US
Practice Address - Phone:972-771-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX97876101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor