Provider Demographics
NPI:1528537446
Name:VILLA, AMY ANGELA (LPC, CRC, ICGC-I)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ANGELA
Last Name:VILLA
Suffix:
Gender:F
Credentials:LPC, CRC, ICGC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6305 CASTLE PL STE 2A
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-1905
Mailing Address - Country:US
Mailing Address - Phone:703-520-1072
Mailing Address - Fax:
Practice Address - Street 1:6305 CASTLE PL STE 2A
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-1905
Practice Address - Country:US
Practice Address - Phone:703-520-1072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007748101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor