Provider Demographics
NPI:1982277653
Name:DE BARROS, VANESSA JEANNE I (LAADC, CATC IV)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:JEANNE
Last Name:DE BARROS
Suffix:I
Gender:F
Credentials:LAADC, CATC IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17921 S AVERY PL
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-3710
Mailing Address - Country:US
Mailing Address - Phone:424-340-9267
Mailing Address - Fax:424-340-2368
Practice Address - Street 1:17921 S AVERY PL
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3710
Practice Address - Country:US
Practice Address - Phone:424-340-9267
Practice Address - Fax:424-340-2368
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALR10420324101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)