Provider Demographics
NPI:1083198782
Name:VANESSA VILLASENOR LICENSED MARRIAGE AND FAMILY THERAPIST INC
Entity Type:Organization
Organization Name:VANESSA VILLASENOR LICENSED MARRIAGE AND FAMILY THERAPIST INC
Other - Org Name:A PLACE OF GROWTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:VILLASENOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-519-8002
Mailing Address - Street 1:591 CAMINO DE LA REINA STE 802
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3110
Mailing Address - Country:US
Mailing Address - Phone:858-519-8002
Mailing Address - Fax:619-684-3788
Practice Address - Street 1:591 CAMINO DE LA REINA STE 802
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3110
Practice Address - Country:US
Practice Address - Phone:858-519-8002
Practice Address - Fax:619-684-3788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1073892956Medicaid
CA1578926192Medicaid
CA1669011599Medicaid
CA1922333665Medicaid
CA1093267361OtherNPI
CA1699020644OtherNPI
CA1821355280Medicaid
CA1548601685Medicaid
CA1942653332OtherNPI
CA1245646009Medicaid
CA1265998322Medicaid
CA1285844456OtherNPI
CA1356963326Medicaid
CA1639564396Medicaid
CA1699159764Medicaid
CA1093267361Medicaid