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General NPI Number Information
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NPI Number | 1467100727
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Entity Type | Individual
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Provider Name | MICHELLE VILLA MSW, LCSW, LCADC
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Gender | Female
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Dates
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Enumeration Date | 03/16/2022
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 500 CRAIG RD STE 100
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City | MANALAPAN
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State | NJ
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Zip | 07726-8748
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Country | US
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Telephone | 856-403-8311
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5282
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City | OLD BRIDGE
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State | NJ
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Zip | 08857-5282
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Country | US
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Telephone |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00394200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW024600
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC06222100
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License Number State | NJ
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