Healthcare Provider Details

I. General information

NPI: 1982517660
Provider Name (Legal Business Name): VANESSA VILLARREAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1669 W MAPLE RD
BIRMINGHAM MI
48009-1230
US

IV. Provider business mailing address

360 PEBBLE BEACH DR
MONROE MI
48162-8851
US

V. Phone/Fax

Practice location:
  • Phone: 248-646-3347
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: