Provider Demographics
NPI:1750073763
Name:SEPUL-AZCARRAGA, VANESSA ANNE-MARIE (MA, HC, SC, LMHC-LP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANNE-MARIE
Last Name:SEPUL-AZCARRAGA
Suffix:
Gender:F
Credentials:MA, HC, SC, LMHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1143
Mailing Address - Country:US
Mailing Address - Phone:760-840-7316
Mailing Address - Fax:
Practice Address - Street 1:120 BOERUM PL APT 3A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6280
Practice Address - Country:US
Practice Address - Phone:760-840-7316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health