Provider Demographics
NPI:1356084156
Name:TRINE, VANESSA (LPCC #11351)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:TRINE
Suffix:
Gender:F
Credentials:LPCC #11351
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19712 MACARTHUR BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2407
Mailing Address - Country:US
Mailing Address - Phone:323-364-6206
Mailing Address - Fax:
Practice Address - Street 1:19712 MACARTHUR BLVD STE 215
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2407
Practice Address - Country:US
Practice Address - Phone:323-364-6206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11351103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical