Provider Demographics
NPI:1073832648
Name:LITTLE VILLELA, LISA MICHELE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELE
Last Name:LITTLE VILLELA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MICHELE
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 N MARKET BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1200
Mailing Address - Country:US
Mailing Address - Phone:916-283-8280
Mailing Address - Fax:
Practice Address - Street 1:601 N MARKET BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1200
Practice Address - Country:US
Practice Address - Phone:916-283-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor