Provider Demographics
NPI:1053772574
Name:PREVILON, DIEULA
Entity type:Individual
Prefix:
First Name:DIEULA
Middle Name:
Last Name:PREVILON
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 1:3018 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5645
Mailing Address - Country:US
Mailing Address - Phone:972-740-0141
Mailing Address - Fax:
Practice Address - Street 1:1518 E FRANKFORD RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5623
Practice Address - Country:US
Practice Address - Phone:972-740-0141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71442101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional