Provider Demographics
NPI:1093313413
Name:VACA, DANIELLE NICOLE BANKSON (LMFT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:NICOLE BANKSON
Last Name:VACA
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 SHELL BLVD APT 104
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2543
Mailing Address - Country:US
Mailing Address - Phone:650-477-4866
Mailing Address - Fax:
Practice Address - Street 1:743 SHELL BLVD APT 104
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-2543
Practice Address - Country:US
Practice Address - Phone:650-477-4866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
390200000X
CA145963106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program