Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YM0800X | Mental Health Counselor |
NPI | 1003355421 |
---|---|
Provider Name | Mayra Segura Villa |
First Address | Sacramento, CA 95811-6919 |
Second Address | Sacramento, CA 95811-6919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2017 |
Last Update Date | 11/06/2021 |