Provider Demographics
NPI:1720638257
Name:VILLAGOMEZ, CHRISTINE (PMHNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:VILLAGOMEZ
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 FORDHAM DR STE 202
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3995
Mailing Address - Country:US
Mailing Address - Phone:910-216-9177
Mailing Address - Fax:
Practice Address - Street 1:1990 FORDHAM DR STE 202
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3995
Practice Address - Country:US
Practice Address - Phone:910-216-9177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK122210363LP0808X
NC5013167363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health