Provider Demographics
NPI:1992483473
Name:DE LA CRUZ, VANESSA (MA LAC)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:MA LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7255 E SNYDER RD UNIT 12204
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-6247
Mailing Address - Country:US
Mailing Address - Phone:520-456-4804
Mailing Address - Fax:
Practice Address - Street 1:310 S WILLIAMS BLVD STE 245
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-7704
Practice Address - Country:US
Practice Address - Phone:602-845-9419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-22098101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health