Provider Demographics
NPI:1568652386
Name:MARLAR, VANCE FRANKLIN (CASI)
Entity Type:Individual
Prefix:
First Name:VANCE
Middle Name:FRANKLIN
Last Name:MARLAR
Suffix:
Gender:M
Credentials:CASI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 FREEPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-3520
Mailing Address - Country:US
Mailing Address - Phone:916-427-6507
Mailing Address - Fax:916-427-6516
Practice Address - Street 1:6130 FREEPORT BLVD
Practice Address - Street 2:102
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-3520
Practice Address - Country:US
Practice Address - Phone:916-427-6507
Practice Address - Fax:916-427-6516
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)