Provider Demographics
NPI:1699199414
Name:VILLANUEVA, ELIZABETH (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6277 A1A S STE 202
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-7515
Mailing Address - Country:US
Mailing Address - Phone:904-834-5051
Mailing Address - Fax:904-216-2154
Practice Address - Street 1:6277 A1A S STE 202
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080
Practice Address - Country:US
Practice Address - Phone:904-834-5051
Practice Address - Fax:904-216-2154
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health