Provider Demographics
NPI:1295819670
Name:VAIL, LUCILLE I (MFTT)
Entity Type:Individual
Prefix:MS
First Name:LUCILLE
Middle Name:I
Last Name:VAIL
Suffix:
Gender:F
Credentials:MFTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4617
Mailing Address - Country:US
Mailing Address - Phone:858-761-6851
Mailing Address - Fax:
Practice Address - Street 1:3142 VISTA WAY STE 205
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3628
Practice Address - Country:US
Practice Address - Phone:760-758-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist