Provider Demographics
NPI:1679224000
Name:VILLANUEVA, KIMBERLY (TCADC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 ASBURY RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-3042
Mailing Address - Country:US
Mailing Address - Phone:563-543-1441
Mailing Address - Fax:
Practice Address - Street 1:2005 ASBURY RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-3042
Practice Address - Country:US
Practice Address - Phone:563-543-1441
Practice Address - Fax:563-583-7026
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAT21113101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)