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General NPI Number Information
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NPI Number | 1184928202
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Entity Type | Individual
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Provider Name | ALLYSON RAE VILLAFANE M.A
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Gender | Female
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | 903 LAKESHORE DR APT 311
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City | LAKE PARK
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State | FL
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Zip | 33403-2826
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Country | US
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Telephone | 631-655-5362
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Fax |
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Provider Business Mailing Address
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Address Line | 903 LAKESHORE DRIVE APT 311
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City | LAKE PARK
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State | FL
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Zip | 33403
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Country | US
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Telephone | 631-655-5362
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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