Provider Demographics
NPI:1053172049
Name:KADIEVA, VIOLETA DIMITROVA (PH D)
Entity type:Individual
Prefix:
First Name:VIOLETA
Middle Name:DIMITROVA
Last Name:KADIEVA
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8598 CORRAL CIR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-7990
Mailing Address - Country:US
Mailing Address - Phone:608-738-6403
Mailing Address - Fax:
Practice Address - Street 1:3110 E ROSEDALE ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-2332
Practice Address - Country:US
Practice Address - Phone:817-531-4232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202264106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist