Provider Demographics
NPI:1811425648
Name:CARDONA, VILMA (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:VILMA
Middle Name:
Last Name:CARDONA
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:
Other - Last Name:CARDONA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, LPC
Mailing Address - Street 1:2115 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-7400
Mailing Address - Country:US
Mailing Address - Phone:970-347-0155
Mailing Address - Fax:
Practice Address - Street 1:1013 9TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4013
Practice Address - Country:US
Practice Address - Phone:970-347-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005740101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional