Provider Demographics
NPI:1619101110
Name:VILLBRANDT, TERESA AMABLE (MA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:AMABLE
Last Name:VILLBRANDT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGHLANDS DR STE 205
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-7692
Mailing Address - Country:US
Mailing Address - Phone:717-625-0025
Mailing Address - Fax:717-625-0009
Practice Address - Street 1:100 HIGHLANDS DR STE 205
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7692
Practice Address - Country:US
Practice Address - Phone:717-625-0025
Practice Address - Fax:717-625-0009
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006065101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional