Provider Demographics
NPI:1942633540
Name:VEGA, WILMARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:WILMARIE
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:WILMARIE
Other - Middle Name:
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1005 LOUISA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-2931
Mailing Address - Country:US
Mailing Address - Phone:787-203-1535
Mailing Address - Fax:
Practice Address - Street 1:1005 LOUISA AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-2931
Practice Address - Country:US
Practice Address - Phone:787-203-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040164641041C0700X
PR195841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical