Provider Demographics
NPI:1114749876
Name:VILLEGAS, NICOLE DENISE (LCSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DENISE
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 GRAND CANYON ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-0776
Mailing Address - Country:US
Mailing Address - Phone:956-648-4676
Mailing Address - Fax:
Practice Address - Street 1:509 GRAND CANYON ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-0776
Practice Address - Country:US
Practice Address - Phone:956-648-4676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX677001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical