Provider Demographics
NPI:1699398610
Name:VILCHIS, CARMEN ISELA (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:ISELA
Last Name:VILCHIS
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SW 108TH AVE APT G7
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1494
Mailing Address - Country:US
Mailing Address - Phone:682-223-3087
Mailing Address - Fax:
Practice Address - Street 1:30 SW 108TH AVE APT G7
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1494
Practice Address - Country:US
Practice Address - Phone:682-223-3087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90944101YP2500X
TX14562101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14661695OtherCAQH