MEDICARE: MR. RICHARD A VILLA LPC, NCC, CSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0701008180	VA
2	101YM0800X	Mental Health Counselor	0701008180	VA
3	101YP2500X	Professional Counselor	61633	TX
4	101YS0200X	School Counselor	61633	TX
5	101YP2500X	Professional Counselor	0701008180	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558679399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD A VILLA LPC, NCC, CSC

Provider Business Mailing Address
First Line	:	7051 HEATHCOTE VILLAGE WAY STE 115
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3197
Country	:	US
Telephone Number	:	804-207-6737
Fax Number	:

Provider Business Practice Location Address
First Line	:	7051 HEATHCOTE VILLAGE WAY STE 115
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3197
Country	:	US
Telephone Number	:	804-207-6737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2010
Last Update Date	:	11/29/2023

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