Provider Demographics
NPI:1184031882
Name:VEAL, STAYSHA (LMFT, DMFT)
Entity type:Individual
Prefix:DR
First Name:STAYSHA
Middle Name:
Last Name:VEAL
Suffix:
Gender:F
Credentials:LMFT, DMFT
Other - Prefix:
Other - First Name:STAYSHA
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2894 SHAVER ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-7174
Mailing Address - Country:US
Mailing Address - Phone:510-417-1043
Mailing Address - Fax:
Practice Address - Street 1:2460 CLAY BANK RD BLDG 8
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-1655
Practice Address - Country:US
Practice Address - Phone:707-399-4847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT99184101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health