Provider Demographics
NPI:1508036179
Name:VANDER ZWART, VICKI JO (MFT)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:JO
Last Name:VANDER ZWART
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 338
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3902
Mailing Address - Country:US
Mailing Address - Phone:858-384-2255
Mailing Address - Fax:858-384-2255
Practice Address - Street 1:3435 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 338
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3902
Practice Address - Country:US
Practice Address - Phone:858-384-2255
Practice Address - Fax:858-384-2255
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41372106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist