Provider Demographics
NPI:1417610759
Name:DAVILA, LIDICE
Entity Type:Individual
Prefix:
First Name:LIDICE
Middle Name:
Last Name:DAVILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 BEARING LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5921
Mailing Address - Country:US
Mailing Address - Phone:407-924-8184
Mailing Address - Fax:
Practice Address - Street 1:7041 GRAND NATIONAL DR STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8380
Practice Address - Country:US
Practice Address - Phone:407-982-7718
Practice Address - Fax:407-704-5953
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health