Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 87000817A | IN |
NPI | 1003075565 |
---|---|
Provider Name | Marlene J Villecco |
First Address | Avon, IN 46123-6646 |
Second Address | Indianapolis, IN 46241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 19/07/2018 |