Provider Demographics
NPI:1235296856
Name:EMMANUEL-PEREZ, VIEMA CHINWE (LPC, LCDC-I)
Entity Type:Individual
Prefix:MISS
First Name:VIEMA
Middle Name:CHINWE
Last Name:EMMANUEL-PEREZ
Suffix:
Gender:F
Credentials:LPC, LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 MAJESTIC PARK LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1763
Mailing Address - Country:US
Mailing Address - Phone:214-448-1436
Mailing Address - Fax:
Practice Address - Street 1:3603 W PIONEER PKWY STE A
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-4535
Practice Address - Country:US
Practice Address - Phone:817-801-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62485101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX348960101Medicaid
TX348960102Medicaid