Provider Demographics
NPI:1760726103
Name:VILLACIS, ASHLEY (MS)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:VILLACIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4988 DAVID RD
Mailing Address - Street 2:APT. 204
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461
Mailing Address - Country:US
Mailing Address - Phone:407-450-1996
Mailing Address - Fax:
Practice Address - Street 1:2112 S CONGRESS AVE
Practice Address - Street 2:STE 104
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406
Practice Address - Country:US
Practice Address - Phone:561-653-6292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health