Provider Demographics
NPI:1013585686
Name:VILLACORTA SEBRAN, CYNTHIA DIANA (LPC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DIANA
Last Name:VILLACORTA SEBRAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5228 VILLAGE CREEK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4430
Mailing Address - Country:US
Mailing Address - Phone:972-913-4738
Mailing Address - Fax:469-666-8197
Practice Address - Street 1:5228 VILLAGE CREEK DR STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4430
Practice Address - Country:US
Practice Address - Phone:972-913-4738
Practice Address - Fax:469-666-8197
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78507101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional