Provider Demographics
NPI:1407553068
Name:VILLALON, ADRIANE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:ADRIANE
Middle Name:
Last Name:VILLALON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11475 CENTRAL AVE APT 27
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-6435
Mailing Address - Country:US
Mailing Address - Phone:757-275-6476
Mailing Address - Fax:
Practice Address - Street 1:11475 CENTRAL AVE APT 27
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-6435
Practice Address - Country:US
Practice Address - Phone:757-275-6476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040146501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty