Provider Demographics
NPI:1821413055
Name:VOVILLIA, JEFFERY (MA, LMHC, LPC)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:VOVILLIA
Suffix:
Gender:M
Credentials:MA, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 NE 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-7749
Mailing Address - Country:US
Mailing Address - Phone:303-847-9172
Mailing Address - Fax:
Practice Address - Street 1:3200 NE 109TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-7749
Practice Address - Country:US
Practice Address - Phone:303-847-9172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0012765101Y00000X
WALH61248633101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor