Basic Information
| Provider Information | |||||||||
| NPI: | 1841723293 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VILLALON | ||||||||
| FirstName: | ZACK | ||||||||
| MiddleName: | LEWIS | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1374 STONEY RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229028258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349604013 | ||||||||
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| Practice Location | |||||||||
| Address1: | 502 OLD LYNCHBURG RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229036550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349721800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2017 | ||||||||
| LastUpdateDate: | 04/04/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0904009776 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.