Provider Demographics
NPI:1083422992
Name:AVILES, EMILY (SUDRC #20102)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:AVILES
Suffix:
Gender:F
Credentials:SUDRC #20102
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 N MARKS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0268
Mailing Address - Country:US
Mailing Address - Phone:559-439-5437
Mailing Address - Fax:
Practice Address - Street 1:7120 N MARKS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0268
Practice Address - Country:US
Practice Address - Phone:559-439-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20102101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)