Provider Demographics
NPI:1710612353
Name:VEGA, GRACIELA (AMFT, APCC)
Entity Type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5266 HOLLISTER AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-4040
Mailing Address - Country:US
Mailing Address - Phone:805-394-8533
Mailing Address - Fax:
Practice Address - Street 1:5266 HOLLISTER AVE STE 205
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-4040
Practice Address - Country:US
Practice Address - Phone:805-394-8551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130070106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist