Provider Demographics
NPI:1053562231
Name:VILLE, VANESSA ILENE
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ILENE
Last Name:VILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 JONIVE RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-9574
Mailing Address - Country:US
Mailing Address - Phone:707-874-9316
Mailing Address - Fax:
Practice Address - Street 1:144 S E ST STE 200
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4794
Practice Address - Country:US
Practice Address - Phone:707-571-5524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health