Provider Demographics
NPI:1104469998
Name:VACHON-LAGUARDIA, BRITNEY KAY (LCSW, AASW)
Entity type:Individual
Prefix:MRS
First Name:BRITNEY
Middle Name:KAY
Last Name:VACHON-LAGUARDIA
Suffix:
Gender:F
Credentials:LCSW, AASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6274 ADOBE RD
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-2650
Mailing Address - Country:US
Mailing Address - Phone:760-367-3290
Mailing Address - Fax:
Practice Address - Street 1:6274 ADOBE RD
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-2650
Practice Address - Country:US
Practice Address - Phone:760-367-3290
Practice Address - Fax:760-367-4867
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88688104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker