Provider Demographics
NPI:1104570134
Name:VILLAR, LORRAINE (MS MENTAL HEALTH COU)
Entity type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:
Last Name:VILLAR
Suffix:
Gender:F
Credentials:MS MENTAL HEALTH COU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 SANCTUARY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-7123
Mailing Address - Country:US
Mailing Address - Phone:631-294-6231
Mailing Address - Fax:
Practice Address - Street 1:1516 E COLONIAL DR STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4726
Practice Address - Country:US
Practice Address - Phone:407-701-7723
Practice Address - Fax:407-894-1780
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH22048101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health