Provider Demographics
NPI:1245898022
Name:VILLA, VALEEN VICTORIA
Entity type:Individual
Prefix:MRS
First Name:VALEEN
Middle Name:VICTORIA
Last Name:VILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 HAWAII KAI DR APT 306
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1521
Mailing Address - Country:US
Mailing Address - Phone:808-953-5777
Mailing Address - Fax:
Practice Address - Street 1:200 N VINEYARD BLVD STE 600
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3952
Practice Address - Country:US
Practice Address - Phone:808-523-8188
Practice Address - Fax:808-524-1021
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician