Provider Demographics
NPI:1083026603
Name:AGUILAR, BIANCA ANGELICA (LPC)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:ANGELICA
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:ANGELICA
Other - Last Name:MOCHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 417147
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-7147
Mailing Address - Country:US
Mailing Address - Phone:518-952-8140
Mailing Address - Fax:518-952-8287
Practice Address - Street 1:2224 N CRAYCROFT RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2811
Practice Address - Country:US
Practice Address - Phone:520-209-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
AZ19772101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03008124Medicaid