Provider Demographics
NPI:1932209913
Name:VAN WINKLE, VICKI DAWN (MFT)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:DAWN
Last Name:VAN WINKLE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:
Other - Last Name:VAN WINKLE, MFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:33 DAVIS LANE
Mailing Address - Street 2:
Mailing Address - City:PENNGROVE
Mailing Address - State:CA
Mailing Address - Zip Code:94951
Mailing Address - Country:US
Mailing Address - Phone:707-338-6177
Mailing Address - Fax:
Practice Address - Street 1:8297 OLD REDWOOD HWY
Practice Address - Street 2:
Practice Address - City:COTATI
Practice Address - State:CA
Practice Address - Zip Code:94931
Practice Address - Country:US
Practice Address - Phone:707-338-6177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33478101YM0800X
CAMFT33478101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health