Provider Demographics
NPI:1093923922
Name:JUSTICE-ROYSTER, VELMA VERNAY (LAADC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:VELMA
Middle Name:VERNAY
Last Name:JUSTICE-ROYSTER
Suffix:
Gender:F
Credentials:LAADC, LMFT
Other - Prefix:MS
Other - First Name:VELMA
Other - Middle Name:
Other - Last Name:TOLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RAS
Mailing Address - Street 1:2949 DEGEN DR
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-2155
Mailing Address - Country:US
Mailing Address - Phone:619-788-7327
Mailing Address - Fax:619-543-7615
Practice Address - Street 1:200 W ARBOR DR # 8681
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1911
Practice Address - Country:US
Practice Address - Phone:619-543-4621
Practice Address - Fax:619-543-3964
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCI12590618101YA0400X
CALMFT107386106H00000X
106H00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist