Provider Demographics
NPI:1023635745
Name:VILLA, ALEXIS NICHOLE (LICENSED SUBSTANCE A)
Entity type:Individual
Prefix:MISS
First Name:ALEXIS
Middle Name:NICHOLE
Last Name:VILLA
Suffix:
Gender:F
Credentials:LICENSED SUBSTANCE A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 S. SOLANO
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001
Mailing Address - Country:US
Mailing Address - Phone:575-522-4004
Mailing Address - Fax:575-522-9017
Practice Address - Street 1:1320 S. SOLANO
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001
Practice Address - Country:US
Practice Address - Phone:575-522-4004
Practice Address - Fax:575-522-9017
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
TXCSA0215451101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator