Provider Demographics
NPI:1811248826
Name:VELEZ, VIRGINIA F
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:F
Last Name:VELEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:F
Other - Last Name:VELEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCDC,CPS,IDAC
Mailing Address - Street 1:2636 WALNUT HILL LANE
Mailing Address - Street 2:SUITE #330
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:76229
Mailing Address - Country:US
Mailing Address - Phone:214-358-6826
Mailing Address - Fax:214-358-6873
Practice Address - Street 1:2636 WALNUT HILL LN.
Practice Address - Street 2:SUITE #330
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229
Practice Address - Country:US
Practice Address - Phone:214-358-6826
Practice Address - Fax:214-358-6873
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6571101YA0400X
TX703049101YA0400X
TX1496-0198101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)