Provider Demographics
NPI:1083838171
Name:VANCE, TAMMY ANNMARIE (MA)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:ANNMARIE
Last Name:VANCE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:JAMUL
Mailing Address - State:CA
Mailing Address - Zip Code:91935-0412
Mailing Address - Country:US
Mailing Address - Phone:619-252-9873
Mailing Address - Fax:
Practice Address - Street 1:7841 EL CAJON BLVD STE C
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-3709
Practice Address - Country:US
Practice Address - Phone:619-697-2388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52926106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist