Provider Demographics
NPI:1013391960
Name:VILLICANA, VICTORIA (MS)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:
Last Name:VILLICANA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:CONSTANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2417 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-3437
Mailing Address - Country:US
Mailing Address - Phone:615-828-3957
Mailing Address - Fax:
Practice Address - Street 1:2417 BAYVIEW DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-3437
Practice Address - Country:US
Practice Address - Phone:615-828-3957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist