Provider Demographics
NPI:1194459057
Name:VILLEGAS, NEREIDA (LADC)
Entity type:Individual
Prefix:
First Name:NEREIDA
Middle Name:
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 11TH AVE NW STE 112
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2739
Mailing Address - Country:US
Mailing Address - Phone:507-225-0400
Mailing Address - Fax:507-208-7737
Practice Address - Street 1:300 11TH AVE NW STE 112
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2739
Practice Address - Country:US
Practice Address - Phone:507-208-0400
Practice Address - Fax:507-308-7737
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306142101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)