Provider Demographics
NPI:1245051580
Name:AVILA, ELISA MARIE (RMHI)
Entity type:Individual
Prefix:MS
First Name:ELISA
Middle Name:MARIE
Last Name:AVILA
Suffix:
Gender:F
Credentials:RMHI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3538 W 74TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1717
Mailing Address - Country:US
Mailing Address - Phone:305-877-7655
Mailing Address - Fax:
Practice Address - Street 1:2000 NW 150TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2870
Practice Address - Country:US
Practice Address - Phone:954-378-5381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26112101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health