Provider Demographics
NPI:1184813354
Name:VILLAVICENCIO, VANESSA VERONICA (MA, LMHC)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:VERONICA
Last Name:VILLAVICENCIO
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20301 19TH AVE NE
Mailing Address - Street 2:SUITE 421
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1285
Mailing Address - Country:US
Mailing Address - Phone:206-579-0585
Mailing Address - Fax:
Practice Address - Street 1:20102 CEDAR VALLEY RD
Practice Address - Street 2:SUITE 107
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6333
Practice Address - Country:US
Practice Address - Phone:206-579-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007024101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health