Individual
AMANDA VILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NCC, LCMHCA
Contact information
Practice address
875 FURR RD, VASS, NC 28394-9106
(910) 660-1900
Mailing address
811 THRUSH DR, VASS, NC 28394-8657
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
A20562
NC
Other
Enumeration date
11/14/2024
Last updated
11/14/2024
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