Individual
LEAH VILLAVICENCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
9910 DUPONT CIRCLE DR E, SUITE 140, FORT WAYNE, IN 46825-1617
(260) 570-4515
Mailing address
5431 ARGIANO XING, FORT WAYNE, IN 46845-8878
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39002526A
IN
Other
Enumeration date
10/18/2016
Last updated
10/18/2016
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