Provider Demographics
NPI:1346756723
Name:VDOVIAK-MARKOW, EMMA RUTH (LMFT)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:RUTH
Last Name:VDOVIAK-MARKOW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 HAZARD CENTER DR STE E405
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4550
Mailing Address - Country:US
Mailing Address - Phone:802-922-6079
Mailing Address - Fax:760-788-9754
Practice Address - Street 1:1012 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065
Practice Address - Country:US
Practice Address - Phone:760-788-9724
Practice Address - Fax:760-788-9754
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA390200000X
CA124639106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program