Doctor Name: | AGRA VINAUDE |
NPI Number: | 1669880076 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 178.010160 |
Business Practice Address: | 4366 Kennedy Dr East Moline, IL - 612444250 |
Business Phone Number: | 3097961603 |
Business Fax Number: | |
Mailing Address: | 4366 Kennedy Dr, EAST MOLINE |
State: | IL |
Postal Code: | 612444250 |
Phone Number: | 3097961603 |
Fax Number: | |
NPI Enumeration Date: | 07/29/2014 |
NPI Last Update Date: | 07/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 178.010160 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |