Provider Demographics
NPI:1710166426
Name:VAN DRIEL, VIRGINIE MARIA (CPC, LCADC)
Entity Type:Individual
Prefix:
First Name:VIRGINIE
Middle Name:MARIA
Last Name:VAN DRIEL
Suffix:
Gender:F
Credentials:CPC, LCADC
Other - Prefix:MRS
Other - First Name:VIRGINIE
Other - Middle Name:MARIA
Other - Last Name:VAN DRIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPC
Mailing Address - Street 1:8112 PEBBLESHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1370
Mailing Address - Country:US
Mailing Address - Phone:402-580-7744
Mailing Address - Fax:
Practice Address - Street 1:8112 PEBBLESHIRE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1370
Practice Address - Country:US
Practice Address - Phone:402-580-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4348101YM0800X
NVCP0236101YM0800X
UT6462286-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1710166426Medicaid