Provider Demographics
NPI:1154189397
Name:VANCE, PALOMA (LEP)
Entity type:Individual
Prefix:
First Name:PALOMA
Middle Name:
Last Name:VANCE
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-2807
Mailing Address - Country:US
Mailing Address - Phone:530-245-7832
Mailing Address - Fax:
Practice Address - Street 1:43 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-2807
Practice Address - Country:US
Practice Address - Phone:530-245-7832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP4473103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool