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General NPI Number Information
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NPI Number | 1760977250
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Entity Type | Individual
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Provider Name | CYNTHIA J VILLACRES LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 679 S NEW HAMPSHIRE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90005-1355
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Country | US
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Telephone | 213-639-0212
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Fax |
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Provider Business Mailing Address
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Address Line | 101 S TOPANGA CANYON BLVD UNIT 564
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City | TOPANGA
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State | CA
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Zip | 90290-2023
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Country | US
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Telephone | 212-961-6168
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | CA
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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 | 110517
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License Number State | CA
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