Provider Demographics
NPI:1467817510
Name:ABILLE, GINEVEVE CHARMAINE VILLARUEL
Entity Type:Individual
Prefix:MS
First Name:GINEVEVE CHARMAINE
Middle Name:VILLARUEL
Last Name:ABILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:GENEVIEVE
Other - Middle Name:
Other - Last Name:ABILLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4412
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579-0412
Mailing Address - Country:US
Mailing Address - Phone:510-589-7916
Mailing Address - Fax:
Practice Address - Street 1:2401 MERCED ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4200
Practice Address - Country:US
Practice Address - Phone:510-589-7916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 101YM0800X
CA123845106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health