Provider Demographics
NPI:1932294428
Name:MCDOWELL, VANESSA MARIE
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:MARIE
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:VANESSA
Other - Middle Name:MARIE
Other - Last Name:HACKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 N MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-3640
Mailing Address - Country:US
Mailing Address - Phone:714-480-4643
Mailing Address - Fax:
Practice Address - Street 1:1200 N MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-3640
Practice Address - Country:US
Practice Address - Phone:714-480-4643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88171106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist